Eubios Journal of Asian and International Bioethics

Transcription

Eubios Journal of Asian and
International Bioethics
EJAIB Vol. 22 (4) July 2012
www.eubios.info
ISSN 1173-2571
Official Journal of the Asian Bioethics Association (ABA)
Copyright ©2012 Eubios Ethics Institute
(All rights reserved, for commercial reproductions).
Contents
page
Editorial: In memory of Sahin Aksoy and Asian
Bioethics
- Darryl Macer
Sahin Aksoy R.I.P.
- Frank J. Leavitt (Yeruham)
Views on Abortion and Sex Selection in Phnom
Penh, Cambodia
- Kouy BunRong
Prognostication
- Dr Lalit K Radha Krishna
Cloud Computing and its ethical issues
- J. Thresa Jeniffer
Indian Marine Turtles in Soup
- A.J. Thatheyus Bio-Ethics and Sustainable
Development: The Need for Proper Policy Making
- S. Panneerselvam
Human cloning: Comments on Iftime (2012)
- K. K. Verma
ABA membership
133
134
135
150
155
158
160
163
164
Editorial address:
Prof. Darryl Macer, Director, Eubios Ethics Institute,
c/o Center for Ethics of Science and Technology,
Chulalongkorn University, Faculty of Arts, Chulalongkorn
University, Bangkok 10330, Thailand
Email: [email protected]
Please renew your Asian Bioethics Association
subscriptions for 2012! New articles are welcome, and
the July issue will include a further paper on Fukushima,
as well as other general topics of bioethics.
Editorial: In memory of Sahin
Aksoy and Asian Bioethics
We were very sad to miss our dear friend, and a
founding member of the Asian Bioethics Association
Board as the first Vice President for West Asia, Dr. Sahin
Aksoy, who passed away with his family around him of
pancreatic cancer this year. The first paper in this issue is
an obituary to Sahin written by the former EJAIB
associated editor, Dr. Yeruham Leavitt. We welcome
Yeruham back to the pages of EJAIB and to the Eubios
community. In the September issue, which is the
th
abstracts of the 13 Asian Bioethics Conference, is the
full memorial lecture that is being delivered by Prof. Umar
Jenie, of Indonesia. We all have expressed our deepest
condolescenes to Dr. Nurten Aksoy, his wife, and also a
founding member of the Asian Bioethics Association, and
their twins.
Readers who are not aware of the work of Sahin,
can goggle his work, or search www.eubios.info for some
of his numerous papers and book chapters. This picture
was taken during the Asian
Bioethics Conference
of
2008 in Yogyakarta (chaired
by Umar Jenie) that followed
the very successful ABC that
Sahin organized in Sanliurfa
(Turkey).
Many
readers
attended the conference
which opened up West Asian
ideas to East and South
Asia.
Sahin first came to Japan in 1997 to the Asian
Bioethics Conference in Kobe, and that Tsukuba
International Bioethics Roundtable that I organized. He
came to a number of the Tsukuba Roundtables, always
willing to help as well as share his views on bioethics in
depth. He would have approved of the first paper by
Kouy Bunrong, who presented data exploring the views
on abortion and sex selection in Cambodia. Sahin
explored such difficult issues as the status of the human
embryo and abortion, offering insights that have
influenced not only Islamic bioethics but Asian and
International reflection on these issues.
Other papers in this issue include medical ethics of
prognostication, information ethics in Cloud computing,
and environmental ethics. Verma offers a commentary of
Iftime’s paper in the May 2012 issue.
For those who have access to iTunes store you
can download for free a new iBook, “Bioethics across
cultures”, which is free to download as an iBook from
iTunes in all countries which Apple has launched iBooks.
This opens up an audience of over one billion persons,
and this is rapidly expanding. The days of printed books
are rapidly disappearing. The book features photos,
videos, interactive activities and other features that can
make bioethics open to all those who have the tablet
computer (currently designed for iPad). A pdf file version
without the interactive features is 40Mb and is available.
The earlier version of this book is Cross Cultural
Introduction to Bioethics, still online.
- Darryl Macer
134
Eubios Journal of Asian and International Bioethics 22 (July 2012)
Sahin Aksoy R.I.P.
- Frank J. Leavitt (Yeruham), Ph.D.
Senior Lecturer Emeritus, Faculty of Health Sciences,
Ben Gurion University, Beer Sheva, ISRAEL
I was shocked to hear, a few weeks ago, from Darryl,
that Sahin was in his final illness. When Darryl wrote me
again to tell me that Sahin had passed away, I was of
course not surprised but it was no less of a shock. Sahin
and I had not got along in recent years. Our friendship
was quite good until our (Israel’s) war in Gaza. We
argued quite harshly over the war. In my humble opinion,
with which some will perhaps disagree, this does not
mean that one of us was a good guy, and the other a bad
guy. Indeed I think that part of being a good person is
being loyal to one’s country and religion. Sahin believed
in the Koran and I believe in the Torah of Israel. I cannot
blame Sahin for believing in the Koran. I of course cannot
speak for him and have no way any more to ask his
opinion, but I trust he does not blame me for believing in
the Torah. Each of us did what he had to do. We argued.
This lead to our breaking off our friendship. Too bad. But
these things happen.
There were better times. At my first bioethics
conference, in Fukui and Tsukuba in l993, someone, I
believe it was Michael Yesley, asked me: “What would
you do if there were a Palestinian at this conference?” I
replied that we would go off together to search for edible
food.
Michael’s question turned out to be prophetic, except
for the fact that Sahin was Turkish. If my memory does
not deceive me, I met Sahin for the first time, in 1997, at
the Asian Bioethics Conference in Kobe. We immediately
paired up and went out looking for edible food. The
dietary laws of the Torah and of the Koran are not
identical. The Koran does not forbid rabbit and camel, for
example, while the Torah forbids them. But there is a
large variety of foods which we both can eat. And more
importantly, we understand each other’s needs. Although
Hindus and Buddhists understand dietary restrictions,
people from religions, which have no dietary restrictions,
can find us both a bit peculiar. So Sahin and I went out
food hunting in Kobe. If I remember correctly, we found
bread, bananas and hard-boiled eggs and we sat on the
kerbstone to enjoy our feast. All fruits and vegetables are
all right for both of us (with a few exceptions for Jews,
such as produce grown in the Land of Israel during a
year when the Torah requires us to give the Land a rest.)
Chicken eggs are also all right for both of us unless they
are fried or cooked with the meat or fat of a forbidden
animal. Hard-boiled eggs present no such problem for
either of us.
I have been discussing religious dietary rules because
they symbolize for me the sorts of things, which bring
followers of the Torah, and followers of the Koran
together in spite of hundreds of years of violence
between us. Maimonides explained that the Torah gave
us dietary restrictions in order to teach us to control our
appetites. I never managed to ask Sahin what explicators
of the Koran say about this matter. But I think he would
have agreed with me that there is beauty in simplicity. I
think we both enjoyed our feast of bread, bananas and
hard boiled eggs as much or more than we would have
enjoyed stuffing ourselves on overpriced food in some
fancy restaurant.
It was at the same Kobe conference that we founded
the Asian Bioethics Association. It seems on the face of it
a crazy idea that with all our wars, terror, and whatever,
all of us from Israel and Turkey to Japan and everything
in between should have enough in common, that we can
engage in a unique and fruitful bioethical dialogue. I still
believe this and I think Sahin did as well.
Sahin and I were the most active members from West
Asia. When Sahin and Nurten were in Israel for a
religious conference in Haifa, he and Nurten came to our
place in Kiriat Arba, Hebron, from whence we could walk
to some of the holiest places in Israel, like the Cave of
the Fathers and Mothers. I was delighted to invite him to
the university in Beer Sheva to speak on bioethics
according to the Koran. For years I had tried to find an
Arab or a Bedouin in Israel who could speak
knowledgeably about bioethics according to their religion.
I never succeeded in finding anyone really learned. This
is too bad. Our teaching hospital, Soroka Medical
Centre, the second largest hospital in Israel, has a large
Bedouin patient population. The majority of patients in
the obstetrics and the infants’ wards are Bedouin.
Good medicine requires communication. This means
that that the staff should have a reasonable
understanding of the cultural needs of the patients. But I
never found anyone who knew enough to help our future
physicians, nurses, etc. to gain something of this
understanding with respect to our Bedouin patients. I
have tried to encourage Bedouin and Arab students to
take a deep interest in this matter. Perhaps it is early to
see results. Sahin was the first bioethicist I ever met who
had a deep, scholarly understanding of bioethics
according to the Koran. His lecture in Beer Sheva was
enlightening not only for me but for quite a number of
physicians and nurses who work with Bedouin patients.
Too bad I couldn’t get him to stay and teach bioethics in
Israel. I also miss the Turkish coffee, which he and
Nurten prepared in our kitchen.
Some years later Sahin invited me to a conference in
his home town of Sanliurfa, in Eastern Turkey. Sahin
kindly explained to me that the name “Sanliurfa” is
composed of two roots, “Sanli” meaning “respected” and
“Urfa”, which many Turks believe refers to Abraham’s
original home, Ur, which is called in Hebrew, Ur Kasdim,
and which people in the West call, Ur of the Chaldees.
Sahin kindly arranged a tour to the archaeological dig at
Haran, which many people believe to be the place,
mentioned in the Torah, where Abraham stayed after
leaving Ur and before coming to the Land of Israel.
Sahin’s conference was one of the most graciously
hosted conferences I have ever attended. Sahin and
Nurten were among the most gracious hosts I have met.
Not only did Sahin arrange these important tours, he
made sure that my dietary needs were met by sumptuous
vegetarian dishes. Sahin was a deeply religious believer
in the Koran. But unlike many, perhaps the majority of,
deeply religious people, Sahin equally deeply respected
other religions. I think this is the main point: believe in
your own religion and respect others. His depth and
toleration should be examples for all bioethicists.
I would like to draw a few more lessons for bioethics
from the difficult experience of Sahin’s death. It is easy to
carry on bioethical discussions about the abstract and
nameless “terminal patient”. It is harder but not extremely
difficult to carry on such a discussion when one, unlike
me, is a clinical doctor or nurse. The doctors have their
“detached concern”, which can make things easier. But
when one knows the patient, not as a patient or as an
example in a professional article, but personally, and
perhaps especially when one has had mixed feelings
about the patient – I respected him but we argued and
ended our friendship – the detachment does not come.
This experience has lead me to think more seriously
about death than I had in the past. I have often taught
doctors and nurses and their students that the most
important thing in caring for the patient who is about to
die is humility. In deciding whether to continue or to stop
life-sustaining care, we need the humility to accept that if
we let them die, we haven’t the slightest idea where and
to what we are sending them. We have no end of
theories about oblivion or heaven or hell or rebirth. But
we have no way whatever to know which, if any, of these
theories is correct. The truth might lie so far from our
current understanding that we wouldn’t recognize it if we
saw it. But in teaching that we need this humility to care
for the patient who is about to die, I do not know whether
I ever really had this humility myself, or whether my
discussions have been facile logical argumentation. If I
haven’t been really humble I hope I can learn how.
A misunderstanding suggested that the people in
Sanliurfa had started to prepare Sahin’s grave while he
was still alive. I had never heard of such a thing. I don’t
think it could possibly happen in Israel. When someone is
still alive, no matter how bad the situation, we don’t give
up hope. Of course we do have doctors who will give
various forms of euthanasia. A high dose of morphine is
perhaps the easiest and the most legally defensible way.
But I cannot imagine relatives treating a patient as dead
while he is still alive. I know about the “Pittsburgh
Protocol” but I don’t like it. As for the rumour, I was
relieved when I learned in the end that it was not true
from Nurten. The fact that I, usually a sceptical person,
had accepted it at face value and mentioned it in the first
draft of this obituary, has taught me, I hope, to be doubly
careful in accepting and quoting things which I read or
hear. We were all so upset to hear of Sahin’s passing.
Not only had I been out of contact with Sahin for some
years, I was also out of contact with Darryl. We had also
quarrelled. It was therefore a great surprise for me to
see an email from him, when he wrote to tell me the sad
news. I highly respect Darryl for rising above our
differences at this sad time. Some people believe that the
deaths of certain people can have mysterious effects on
our lives. Perhaps Sahin had something active to do with
initiating the renewal of contact between Darryl and me.
But this is only a guess. We cannot really know anything
about what, if anything goes on in other worlds. Only the
revealed things are for us. The secret things are for God
(Deuteronomy XXIX, 28).
Goodbye, Sahin. I forgive you for everything you said
which offended me. I ask you to forgive me as well.
135
Views on Abortion and Sex
Selection in Phnom Penh,
Cambodia
- Kouy BunRong
Vice-President, UNESCO Youth Peace Ambassadors in
Cambodia, Phnom Penh, Cambodia
Abstract
This present paper sought to discover the ethical
perspectives of Cambodian urban population and
medical practitioners on sex selection issue. The aims
are to discover whether there is sex selective abortion
ever practiced in the country and to inspect the reasons
hidden behind the decision of abortion practice in the
country. This study employs the use of questionnaire for
seventy-nine people from eight districts in Phnom Penh,
the capital city of Cambodia. Moreover, two health
professionals were interviewed to explore a clearer
aspect in term of sex selection notion in the hospital. The
finding demonstrates that Cambodia did not have
tendency towards the practice of sex selection yet.
Nevertheless, sex-selective abortion was indicated to
happen if parents already have one or more children on
particular gender. Public opinions on gender preference
and other medical, historical, religious and socioeconomical parameters are discussed.
1. Introduction
“It is a girl!” This sentence could be a positive or a
negative acclamation. According to reports from All Girls
1
Allowed Organization, this is a provocative gender
biased sentence linked to deaths of uncountable baby
girls across the world. The desire to have a child of
particular sex can be traced back through centuries.
Kings were desperate to have a son to be heir to his
throne. Peasants desire sons to help them with
agricultural work. All of these apparent preferences can
compound to create stereotypes of gender discrimination.
With the advancement of technology such as Assisted
Reproduction Technologies (ART), sex selection at
embryo or fetal stage is possible through preimplantation
diagnosis or abortion. Many persons in China and India
practice female infanticide (a type of gendercide) as well
as abuse or neglect of female babies.
This paper will focus on selection of the gender of
the fetus according to parents’ desires, so-called sex
selection. Sex selection embraces attempts to choose or
influence the sex of a child before and during pregnancy
and after birth (Toebes, 2008). Sex selection could be
considered as one form of gender-based violence since it
deprives the rights to live and other requisites to the life
of females compared to males.
Sex selective abortions have been classically
performed in prenatal diagnosis for medical reasons. For
instance, when a mother who carries a sex-liked disease
like hemophilia conceives a fetus, then sex selection
followed by selective abortion may be legally granted in
1
Retrieved
on
May
1,
2012
from
http://www.allgirlsallowed.org/gendercide-video-2-minutes
136
countries which permit abortion (Aghajanova &Valdes,
2012). On the other hand, there are two situations for an
individual to consider choices of sex selection regardless
of sex-linked genetic disease (Macer, 2000, p.113). The
first situation is when a family has a preference for the
sex of the next child, for example, if the sex is different to
the sex of already born children. The other reason might
be linked to social and cultural reasons, which leads to
gender inequality and feminicide is tolerated.
There has been research conducted on sex
selection from different domains. The ethics of sex
selection are still being debated after decades of
controversy. The underlying difficulties concerned with
the status of embryo and the possible social
consequences of sex selection (Grant, 2006, p.1659).
Issues such as the extent to which an embryo should be
considered as human, or the likelihood of a social
imbalanced sex ratio between the two genders, male and
female, at the time of reproductive maturity arose and
there are widely different viewpoints. Some research
studies sought to legalize sex selection (McCarthy,
2001). Some examined the case of sex selection under
the international human rights laws and various national
legal schemes (Toebes, 2008). Most research studied
the ethical concerns and manners towards sex selection
in various countries (Dickens, 2002; McDougall, 2004;
Akchurin & Kartzke, n.d; Liao, 2005).
This paper studied the sex selection issue in
Cambodia. It aims to understand the perceptions of
parents (and potential parents-to-be) regarding their
ethics toward the practice of sex selection which leads to
the gender-driven abortion or female (and male)
infanticide by cross checking with the perspectives of
experts in the medical field. More importantly, this study
intends to explore reasons associated with feminicide in
Cambodian society (if any), specifically in the eight
districts of the city, Phnom Penh, by examining people’s
attitudes to these issues, the biological and social
aspects of gender, methods of sex selection, and socioeconomical parameters.
2. History, Tradition and Myths about Sex Selection
Sex selection is not a recent concept; it emerged
and developed a long time ago with deep historical roots.
As early as 330B.C, there was a practice held by
Aristotle. He had a formula that making love in the north
wind would conceive a male child and in the south wind,
a girl. Likewise, Hippocrates had his own prescription. It
is said to tie a string around the right testicle to stimulate
the production of male seed, or on the left, if a daughter
is sought. The Greeks believed that the male determining
sperm were derived from the right testicle (Liao, 2005). In
similar sense, medieval alchemists had an even more
exotic recipe for a son: a precoital drink of lion's blood is
prescribed (Wallis & Pelton, 1984). 4000 year ago, the
Egyptians believed that women of a “greenish” cast of
complexion were “certain to have boys” (Markle, 1971).
Likewise, Dickens (2002, p.335) introduced a Jewish text,
“The Babylonian Talmud” which was completed towards
the end of the fifth century A.D. It advises couples on
means to favour the birth of either a male or female child.
The Jewish people further held a belief that women has
to emit her semen before the man if one wants the child
to be a boy or else it will be girl. Some others said that
food with high sodium and potassium such as bananas,
cherries, grapes, oranges, peaches, melons, broad
beans, sprouts, tomatoes, or sweet corn are diets to
increase the chances of a male fetus (Liao, 2005, p.116).
It is universally known that Chinese are famous for
eagerly longing for a baby boy to continue the family line.
th
In the 13 century, the Chinese used a “conception chart”
or “gender chart” to predict the fetus gender by crossreferencing the age of the mother at the time of
conception with the month the baby was conceived. For
example, if the mother was 22 years old at the time of
conception and the baby was conceived in April, the
chart predicts the baby will be a baby girl (See Table in
the Appendix 1). This chart was discovered in a royal
tomb over 700 years ago (Chinese Birth Chart
Organization, n.d).
Over the course of human history, the gender of a
newborn baby has mostly been a surprise and despite
the beliefs discussed above, mostly is an uncontrollable
aspect of the life cycle. Nevertheless, there are beliefs
attached with meanings of a baby boy or a baby girl. In
Neo-Confucian inspired sayings, there are plenty of
mottos posting the burden on women’s reproduction such
as “women’s greatest duty is to produce a son”, and
“There are three non filial acts: the greatest of these is
the failure to produce sons.”
In “The Good Earth”, an English novel written by
Pearl S. Buck (1931), the author portrays how Chinese
couples would anxiously look forward to the arrival of the
new baby. Meanwhile, Pearl reveals how the
superstitious belief of giving birth to a male or female
baby affected the family living conditions and reaction
from the whole village. She described the situation as:
“[…] Wang Lung (the male protagonist) and O-lan (the
female protagonist) cultivate a bountiful and profitable
harvest from their land. O-lan becomes pregnant, and
Wang Lung is overjoyed when O-lan’s first child is a son.
[…] After O-lan gives birth to a daughter, a terrible famine
settles on the land. In the midst of this crisis, O-lan gives
birth to another daughter. […]” (SparkNotes Editors,
2003)
In pre-Islamic Arabia, sex selection was an emotive
2
subject in the Qur’an. One belief is that the father will
become despondent when a daughter was born to him
(Haleem, 1993, p.9). There is a practice that some
daughters were buried alive by their father. Some
Bedouin women wrote poems, lamenting their treatment
by such husbands.
A symposium of Muslim scholars discussed the
questions of choosing the sex of the child whether
Muslim parents could take advantage from the
advancement of modern technology and whether this
goes against the will the God. The conclusion is that
everything done by modern medicine is in the power and
will of God and within the framework of laws and causes
that God created in nature.
For Islam, the vital date of 120 days has been seen
as the beginning of obvious life being breathed into the
fetus. Therefore, abortion from that time onwards is
2
The prime authority in Islam and the fundamental source of
Islamic teaching, contains references to biological facts right
from the second verse that was revealed to the Prophet
Muhammad which speaks of the power of God shows in the
creation of man form a simple origin. Haleem, (1993). Medical
Ethics in Islam. p.1
prohibited for two reasons. Firstly, it is an aggression
against a “living being”. Secondly, it entails the “the
obligation of payment of compensation” to the full
recognized extent in Islamic law if the fetus is aborted
alive. If the fetus is aborted dead, the compensation is
less. Nonetheless, if the continuation of pregnancy
beyond 120 days would inevitably lead to the death of a
mother, then abortion becomes an “obligation”.
Theoretically, mother is regarded as more important
because she is the “originator of the fetus” (p.12). Her life
is already well established with social rights and
obligations.
Not to mention that a fetus in Islam has a legal
identity, which is separate from that of its mother.
Therefore, if the pregnancy causes no threat to the life of
a mother, neither the parents nor a third person, from 120
days onwards, has the right to bring about abortion
(p.13). If these individuals insist to do, they ought to face
the religious responsibility as well as financial
responsibility for the compensation according to Islamic
norms as well as the social legal liability.
As shown, sex selection existed in pre-Islamic
Arabia. As time goes by, the Islamic teaching, norms,
and legal liability in the current state encourage no
gender discrimination, at least at the point of birth.
In Cambodia, there has been a traditional practice
and belief during childbearing to predict the gender of the
fetus. There are sayings passing from generation to
generation that during the conceiving period, if a mother
tends to be fresh, joyful and beautiful, then she is highly
likely to conceive a baby girl. In contrast, if the mother
easily turns upset, then the fetus is a baby boy. There is
another longstanding belief. If people long to know the
gender of the fetus, it is advisable to call the woman
while she is walking. If she turns her face on the left, then
the fetus is a girl. In contrast, a baby boy is predicted if
the woman turns her face on the right. Besides these
practices, there seems to have no mention about how to
conceive a son or a daughter.
The phenomenon of sex-selective abortion could be
discussed through case studies in many countries
particularly China and India, the two most populous
states. These patriarchal-based counties share a brutal
fact on abortion practice and female infanticide. These
countries place more value on sons to promote socioeconomical values in the society. More discussion will be
made later in the attitudes towards sex selection section.
3. Modern Technologies for sex selection
Building upon these traditional beliefs, there are a
number of new technologies that have been employed
recently. The simple and economical way is through
ultrasound, which could determine the sex of the fetus
during the second trimester (Rochman, 2011). There are
other procedures to detect the fetus such as Chorionic
Villus Sampling (CVS) or amniocentesis. The
development of amniocentesis alerted the public in the
mid-1970s to the scientific potential for prenatal
determination of fetal sex (Dickens, 2002, p.335), and
progressive decriminalization of abortion afforded more
parental choices about continuation of pregnancy in
many countries.
However, these procedures carry a small risk of
miscarriage. Non-invasive tests such as maternal blood
sampling can also detect the sex of the embryo within 6
137
weeks of gestation (Macer, 2009). Another method is
known as Pre-implantation Genetic Diagnosis (PGD). It is
a reproductive technology that enables potential parents
to learn the genetic makeup of their early embryos
conceived through in vitro fertilization (IVF), in order to
avoid implanting an embryo into the mother that carried
the DNA for a particular disease or disorder such as
hemophilia (Malek & Daar, 2012, p.3; Liao, 2005, p.116).
In a typical PGD cycle, only two embryos which are free
from disease-causing mutation or abnormality are
selected to be transferred into a women’s uterus. In the
use of PGD for sex selection, the embryo is implanted
only after its sex is determined. Thus parents might pick
a certain sex of the embryos for non-medical purposes by
taking the advantage of PGD.
For instance, in 2006, research published in the
journal Fertility and Sterility found that 42% of clinics that
offer PGD for genetic purposes also offer sex selection
(Rochman, 2011). Grant (2006) wrote in his opinionated
article, “at present the most reliable method of sex
selection is by means of PGD” (p.1659). In addition, IVF
has also led out ways for the egg-sharing scheme, which
was first introduced in United Kingdom in 1998 (Gürtin,
2012). Egg-sharing scheme was designed specifically for
infertile couples who seek the chance to become parents
or couples who particularly long for a child of opposite
sex from the current children through another woman’s
egg donation. The intention could be both empathic and
morally questionable. IVF for such a process is
expensive, depending on the country (Gürtin, 2012). How
about the poor? Undoubtedly, two methods are
commonly excelled during and after pregnancy: abortion
and infanticide. These points will be illustrated through
cases in different countries especially China and India in
the following part.
Liao (2005) introduced a future example of the use
of genetic engineering, by inserting the “gendered” genes
of the desired sex in a virus-like organism and use
germline engineering to alter the sex of an embryo. It
should be noted that no one has said that they
succeeded to use genetic engineering for sex selection
yet.
4. Attitudes Towards Sex Selection
Recent research conducted at Queen’s University in
Ontario, Canada reported that, “women want daughters
and men crave sons” (Rochman, 2012). The researchers
surveyed more than 2,000 students and staff at the
college about their gender preference for offspring. In
contrast to their assumption that the participants would
show no or little preference on gender, they found out
that there is a significant preference for gender of their
offspring regardless of how the researchers worded the
questions. The respondents answered three questions
including, “what gender would you prefer your firstborn
child to be (or did you hope for if you already have a
child)?” “If you were to have (or do have) more than one
child, would you prefer the majority to be male or
female?” And “if you were to have only one child, what
gender would you prefer it to be?” Thus the sexselection notion does not exist only in Asia as some
stereotypes would portray. As mentioned in a Gallup Poll
in the USA, it was said that the notion has existed for at
least 70 years as indicated through the comparisons of
the first poll result in 1940 and that of 2012, for the
138
question “if you could have only one child, which gender
would you prefer?” The result for 2012 was 40% prefer
boys and 28% girls amongst 1,020 American adults (Kim,
2011). This is not much different from the first poll results
in 1941, which were 38% has son preference and 24%
went for daughters. The finding was analyzed based on
age group, educational level and political orientation.
Although it is found globally, sex selection has been
most widely reported across Asia. A report published by
the United Nations Population Fund (UNPF) estimated
that 95 million expected female babies in Asia were
reported as “disappeared” in 2000, 85% of them were in
China and India (Johnson, 2007). Within the approximate
12 years, Mara Hvistendahl, a journalist and an author of
a new released book, entitled Unnatural Selection:
Choosing Boys Over Girls and the Consequences of a
World Full of Men, documents a new estimate for the
number of missing female babies. She wrote, “Asia alone
has seen the elimination of 160 million future women,
which is more than the entire female population of the
United States” (Gammage, 2011).
The decreasing girl baby ratio in India remains high
for the last decade. UNICEF conducted comprehensive
studies in Indian society, which reveals an organized
pattern of discrimination against women. The sex ratio
declined from 972 female compared to 1000 males in
1901, and to 935 in 1981 (Venkatramani, 1992, p.125). In
2001, the case reported sex ratio was 108:100
nationwide, but as high as 120 in some areas. According
to a U.N. Children's Fund report in 2006, 7,000 girls go
unborn in India each day (Johnson, 2007). The situation
seems never to get better. The result of 2011 census
reveals that far fewer girls than boys are born in the
country each year. This indicates a rapid decline in child
gender ratio that reflects persistent sex-selection
practices. The number declined from 927 to 1,000 in
2001 to 914 females to every 1,000 males in 2011 for
children 6 years old and younger (Wilson, 2011). The
Economist reported that there were 600,000 Indians girls
that go missing every year by comparing the number of
girls actually born to the number that would have been
born under a normal ratio which, in sum, resulted in an
elimination of ten millions female lives lost to abortion
and sex selection.
In China, the strong Confucian belief has affected
the children born by the one child policy, the main reason
causing sex-selective abortion and widespread use of
female infanticide. The policy was enacted in 1979 by the
Communist Party to curtail the rapid population
expansion. The Economist published an article
th
“Gendercide, the worldwide war on baby girls” on the 4
of March 2010 reporting that the sex ratio for the
generation born between 1985 and 1989 was 108:100,
which is outside the natural range. For the generation
born in 2000-2004, there were 124 boys for every 100
girls. The Chinese Academy of Social Sciences in 2010
shows that the ratio is 123 boys per 100 girls, which is
biologically impossible without human intervention.
Nevertheless, the gender imbalance ratio keeps
growing wider year after year. In an analysis of Chinese
household data carried out in late 2005, “only one region,
Tibet, has a sex ratio within the bounds of nature.
Fourteen provinces, mostly in the east and south, have
sex ration at birth of 120 and above and three have
unprecedented levels of more than 130.” The sex ratio
varies between different places in China according to the
criterion determined by local officials. For instance, in
coastal provinces, 40% of couples could have a second
child if the first one is girl whereas in central and southern
provinces, everyone is permitted to a second child either
if the first is girl or if the parents suffer hardship. In the far
west and Inner Mongolia, the provinces do not really
operate one-child policy. More cases were reported
about the death toll of female babies. To illustrate, the
ratio in Guangdong is 120:100; In Anhui is 227:100; In
Beijing municipality, the same source lists the sex ratio
as 275:100. The death toll of female babies keeps rising
to the figure that there are almost three baby boys for
each baby girl.
A broad figure of the number of missing girls was
published in an article in British Medical Bulletin that “3040 millions of females are missing from Chinese society
due to the direct consequence of the widely practice of
sex-selective abortion and the culture of son preference”
(Nie, 2011, p.18).
Sharing the same notion as China, Vietnam, in her
Confucian-based society, prizes male heirs to carry on
the family line and care for parents at their old age. For
Vietnam has a history of strict population control, couples
were forbidden to have more than two children. As a
result, families went to great lengths to ensure that at
least one was a son including aborting girl babies,
especially if they already had one daughter. In 2006, the
United Nations Population Fund reported that some
25,000 expected baby girls went “missing”. This statistic
came from observing that some expectant parents abort
“unwanted” girls once they learn the sex of the fetus
through ultrasound technology. The ratio of newborns
was at 110 boys to every 100 girls, which was higher
than the natural rate of 105 to 107 boys for every 100
girls (Johnson, 2007). A census conducted in Vietnam in
2009 indicates that the sex ratio imbalance was 110.5.
The census also reveals that sex selection is practiced
most in the northern Red River Delta provinces and
amongst wealthy families. The ratio is as high as
130.7:100 (Lacono, 2012).
In Thailand, research on gender-preferences was
conducted in June-July 2010 among the Thai public and
health professionals in Bangkok. The result found that
out of 65 respondents, 35 persons preferred boys, 18
girls and 12 expressed no preference (Chaipraditkul,
2010, p.10). The researcher also interviewed three
doctors regarding gender selection in Thailand. The
answers varied from one doctor to another. The first
doctor said that there was no preference with the
explanation that “we [the Thai] don’t have that kind of
tension to pick the gender of the baby”. The second
doctor said there was boy preference in the
circumstances that the family already had a very talented
woman. The last doctor drew a point for girl preference in
case that the girls are talented. In all, the case remains
ambiguous whereas the public fact shows a strong
preference to baby boys.
In Cambodia, the abortion law was passed in 1997.
Nonetheless, Cambodian people are still uncertain if
abortion is legal due to the fact that abortion is not a “free
topic” to mention in Cambodian society (Popular
Magazine, 2011, p.24). According to the report which
summarizes the findings of the 2010, Cambodia
Demographic and Health Survey (CDHS) conducted by
the Directorate General for Health (DGH) of the Ministry
of Health and the National Institute of Statistics of the
Ministry of Planning, five percent of women aged 15-49
years in Cambodia report having had an abortion in the
five years before the survey, which was a slight decrease
from 8% reported in 2005. The result points out that
abortion is not common. Nevertheless, is sex-selective
abortion an issue in Cambodia despite the low reported
incidence of abortions?
5. Research Methods
The research questions for the study were:
1. Is sex selection widely practiced in Cambodia or
it is just a myth?
2. Can sex selection be ethically tolerated? If so, in
what context?
3. What are the perceptions of parents and medical
expertise towards sex selection?
4. How do parents from different socio-economic
family think of sex selection?
5. Why do parents abort fetuses?
Participants
The targeted participants were people above the
age of marriage from eight districts in Phnom Penh, the
capital city of Cambodia. A total number of the
participants for this research were 79 people, 25 males
and 54 females, who were randomly selected from
different genders and socio-economical status to provide
diverse perspectives towards the sex selection issue.
The exact number at each respective districts was as
follows: 13 from Chamkar Mon district, 5 from Duon Penh
district, 7 from Prampir Meakara district, 12 from Tuol
Kork district, 4 from Dang Kuo district, 12 from Sen Sok
district, 14 from Meanchey district and finally 12 from
Russei Kaev district. The average age of the participant
was 37 years old. The median was 33 years old. One
participant did not specify her age. Each participant was
asked to fill out the questionnaires containing 22
questions individually. The two major ethnic groups
dominated the replies. The first group was indigenous
Khmer, which accounted for 32 respondents. Another
group was the 47 Sino-Khmer respondents.
Also interviews were conducted with two midwives
from the National Maternal and Child Health Center, the
biggest maternal hospital located in Phnom Penh,
Cambodia. The first midwife has twenty-six years
experiences in conducting abortions. The second midwife
has been working in the delivery department for ten
years.
Public sample
A convenient sampling strategy was adopted in the
eight districts in Phnom Penh. To achieve this, I went to
the eight districts and asked the participants who were
willing to join this research. Maximal Variation Sampling
was applied for data collection, to discover the different
perspectives of individuals from diversity circumstances
and characteristics. In the quantitative research
questionnaires, the objective was to obtain spontaneous,
responsive answers from the participants who filled the
questionnaires in a comfortable and non-offensive mood,
as abortion is a private issue.
139
Professional interviews
To discover professional ideas to answer the
research questions, in-depth interviews with two medical
professionals were made, with four others refusing to be
interviewed, mainly saying that they were too busy. Rich
information was obtained from the interviews.
Two types of interview were employed: one-on-one
interview and telephone interview in order for seeking
perspectives on sex-selective abortion in Cambodia
based on the midwives’ experience. The one-on-one
interview was conducted with the first midwife, and the
second midwife was telephone interviewed. Both
interviews were conducted in a free and relaxing manner,
to allow the interviewees to share their ideas liberally,
spontaneously and expressively. Basically, a series of
questions were designed to ask the interviewee to
respond to the five major research questions. Moreover,
unstructured interview questions were prepared to probe
extra information to help explore reflection on this issue.
An audio record from a health program aired on
television was also used. It was about medical abortion
using a pill, which illustrated more details on how
abortion is done in Cambodia.
Procedures
The questionnaires were distributed to the eight
districts during 14 February until 31 March 2012. There
were two versions: one in English and another one in
Khmer language in order to reach respondents from
different families and different educational backgrounds.
A total of 80 Khmer questionnaires and 20 English
questionnaires were distributed. However, 69 Khmer
questionnaires and 10 English questionnaires were
returned. Most importantly, the participants had full right
and freedom in filling the answers because all the
instructions on how to fill in the questionnaires were
precisely explained on the first page of the
questionnaires itself (see the Appendix 3). Nevertheless,
the participants were recapped about the purpose of the
research prior to their answering to carefully read the
instructions. Participants could also ask inquiries in case
they did not fully understand the questions. Some
participants brought the questionnaires home and
returned after they finished. Moreover, the participants
were encouraged to write down the spontaneous
answers that popped up in their mind. It is a belief that
the first-appeared answers were rather truthful.
I contacted three public hospitals and two
international organizations working on health promoting
issue in Cambodia. Two public hospitals and one
international organization working on reproductive health
rejected the interview, giving the reason they were too
busy. Another international organization asked to wait for
their reply, yet no response was given.
Both interviews were conducted in different ways
because of the busy schedules of medical staff. The oneon-one interview with the first midwife was conducted at
her house. The second midwife was interviewed through
a telephone. Consent was obtained in both cases for
tape recording to ensure no data loss. Open ended and
opportunistic questions had been used to probe as many
details as possible. The main language of the interview
was Khmer. The interview was transcribed and translated
into English later.
140
Data collection
There were several challenges in the process of
data collection. First of all, abortion is a private issue in
Cambodia. Thus, fifty percent of people asked rejected to
take part in the research. Nevertheless, efforts to explain
about the purpose and the benefits of this research study
was carried out. Secondly, Phnom Penh is quite big,
2
covering an area of 678.46 km according to Phnom
3
Penh Capital Hall. There are eight districts. The
research required travel to different districts asking
volunteers to answer the questionnaires. Thirdly, the
questionnaires were supposed to be returned
immediately after the participants finished answering.
However, the participants had to also work and had a
limited time. Therefore, to ensure that the answers filled
in the questionnaires were not “forcefully” given, the
participants were allowed to bring the questionnaire
home and filled in when they were in a relaxing mood
after work.
Regarding the interview with medical professionals,
bureaucracy and complex papers, and refusal to pay
incentives after the interview, were the main challenges.
Category development
The data in the questionnaire was coded. However,
there were some questions (e.g. questions 14, 21) that
require the respondents to write down their comments.
Therefore, the answers were grouped manually using an
open-coded approach in order to divide data into
segments and then scrutinize them for commonalities.
For question 14, nine categories were developed. The
categories include: they are our children, so we love
them, people have same value, equal Human Rights,
function is different; self-realization/education is
important, same ability/ capacity, as long as they are
healthy, should not control nature and last, not stated
(see Appendix 2).
For the interviews, an inductive approach was used
to code the main concepts. Transcripts were translated
into English and later they were analyzed. Since there
were no initial codes set, research questions were relied
upon largely on to develop the codes. Eight themes were
developed. They were Concepts of Sex Selection and
Legal Conditions for Abortion in Phnom Penh; Is Sex
Selection a Myth?; Gender Preference amongst
Cambodia, and Sino-Cambodia; Abortion Methods,
Abortion Safety and Its Drawbacks; Pluses and Minuses
on Abortion and Its Service in Cambodian Society;
Ethical views on Sex-selective Abortion from Midwives’
Perspective; and finally Additional Comments.
6. Findings
Socio-economical status and family situation of
Phnom Penh residents
Socio-economical status
There might be a connection between a family’s
financial situation, position in society as well as the
current numbers of sons and daughters. Therefore, many
demographic questions were investigated. Figure 1
shows a pie chart indicating the percentage of monthly
income of the participants compared to the general data
for residents.
3
http://www.phnompenh.gov.kh/phnom-penh-city-facts-99.html
Figure 1 illustrates that 33% of the respondents
received less than USD250 for their monthly salary while
38% obtained income between USD250-USD500. Only
one fifth reported a salary more than USDD500. 8% did
not state about their income. Among the 79 total
respondents, 13 worked in the government sector, 15
worked in the academic sector, 35 were in the business
sector, and there were 15 housewives.
Figure 1: Percentage of monthly income of respondents
Family situation
Family situation in terms of the number of years of
being married and number of children per family were
studied in order to examine how these factors might
affect the abortion choice. The outcome was that the
average married years was 13 years and a half. The
median is 10 years.
Table 1: Chart illustration on number of children, sons
and daughters of the respondents
Number of
Children
1
2
3
4
More than 4
Not stated
%
31%
34%
12%
9%
5%
9%
Number of
sons
0
1
2
3
6
-
%
30%
44%
16%
5%
1%
4%
Number of
daughters
0
1
2
3
4
-
%
29%
45%
16%
5%
1%
4%
Correspondingly, when asking about the numbers of
children in the family, the result indicated that Cambodian
urban couples tend not to have many children. Table 1
showed about the percentage of numbers of children,
sons and daughters of total respondents. Thirty one
percent stated that they had only one child. The
percentage slightly increased to 34% for two children.
However, the percentage dropped remarkably to 12% for
three children. Only 9% answered they had four children.
Those who had more than four children accounted for
merely 5%. By comparing the ratio between sons and
daughters, we could see that there is no much gap
between the percentage in term of numbers of sons and
daughters in the family. The figure was pretty well
balanced.
Gender preference on the sex
Phnom Penh
As Figure 2 illustrates, most
Phnom Penh city seem not to
regarding the sex of their children.
of the children in
parents who live in
have a preference
The results for both
son and daughter preference were similar, with 19% of
the participants preferring to have a son(s) while 20% of
participants preferred a daughter(s). 1% of the
participants did not respond to the question.
Figure 2: Percentage of Preference on Sex of the
children of the respondents
Son preference
There were various reasons given by those 15
participants who desired a son. We could consider that
the reasons cover three domains: self and family
preference, the nature of the sons, and hope for the
future. To begin with, 11 out of 15 participants said that
the preference was to meet the desire of their
husband/wife or their family (e.g. grandparents). This
links to the dominant views on the nature of the sons
usually portrayed in the minds of people in the society. It
is believed that sons are more obedient, helpful and can
take care the rest of the siblings because they are strong
in term of both physical body and emotion. Sons will also
have to sustain the family line. This ideology is rooted
and partially held by Sino-Cambodia descendants in
Phnom Penh.
Moreover, 9 out of 15 participants said sons are
easier to be brought up than daughters. There is an old
saying widely known for the praise on males that, “males
are gold, females are white cloth. Even though gold falls
into the mud, it remains clean after washing with water. In
turn, white cloth will be left with a stain even if it is
washed.” Due to this ideology, sons are offered with
more freedom. They are allowed to go freely far away
from home and earn money to support the family’s living.
With economic capability and expectation to be the
breadwinner of the family, sons become the invested
hope of the family directing to prosperity.
Daughter preference
Similar reasons are shared amongst the participants
who voted for daughter preference. In the minds of this
group of respondents, to get a daughter means to satisfy
the needs of oneself, and the husband/wife’s desire as
well as that bigger family. 9 out of 16 respondents
mentioned motivations including daughters are easier to
bring up due to the fact that daughters listen to parents’
advice more than sons. In addition, 11 out of 16
respondents mentioned that daughters could help with
household chores and nursing younger siblings. Parents
also tend to hold hope that that they could live with their
daughters’ care in their old age. Less socially expected
than sons, daughters have nothing to do with sustaining
the family line. Rather, daughters are usually wanted in
case that the couples have only sons. Last, fashions and
lovely girly stuffs are displayed and sold at markets also
141
affect parents’ decision for daughter preference as
responded by one respondent.
No preference
The 47 respondents who stated no preference for
the sex of their children offered comments why they have
no gender preference. Interestingly, many parents seem
to have very instinctive mindsets. The answers were very
interrelated and common.
For instance, for the most commonly mentioned
idea, “they are our children, we love them”, almost all the
respondents wrote down exactly the same answer. Only
six participants (#22, 24, 32, 43, 62, 70) did not mention
about this theme. For instance, participant number 5
wrote, “The gender of my baby, either boys or girls, is
not crucial for me. They are all my children and have the
same capacity and value in the society.” This partially
refers to the second code “people have the same value”
(see also #2, 8, 24).
Participant number 27 had similar ideas, “It is us
who gave birth to the children, either boys or girls. We
have to take good care of them both physically and
emotionally especially giving equal education to them.
Both sons and daughters could help do housework. They
could sustain the family line, go to work abroad in order
to feed the family and look after parents.”
Other categories included, “Equal Human Rights”
(#28, 56, 59, 63), “ Function is different” (#22, 24, 62, 63,
70), “Self-realization/ Education is important” (#3, 8, 27,
64, 75), “Same ability/ capacity” (#3, 27, 40), “As long as
they are healthy” (#4, 30, 42, 43) and “We should not
control nature” (#5, 11, 30, 43).
Here are some original comments on several codes.
Participant number 63 made the point on equal rights of
human being that, “I love both sons and daughters. Both
want to live. I can’t practice infanticide. There needs to be
balance gender ratio between sons and daughters, so
that they could build and develop the country for the
better happiness in the future.”
What is more, some participants shared their views
that both genders have different working domains. For
example, participant number 22 wrote, “Sons and
daughters are all having flesh and brain. They could
study and work on different tasks.”
All comments are in the Appendix 2.
Abortion practice in Phnom Penh
Among the 54 female participants, 14 reported
having had an abortion, which would equal a 26%
abortion rate. The reasons behind abortion varied
amongst respondents, but did not indicate any sex
selection related reasons. Surprisingly, no respondent
answered that they used it to specifically abort a baby
girl. In contrast, one participant reported having aborted a
baby boy. Five participants explained that they did not
have enough financial support to bring the baby up at the
time of conceiving. There were two participants who said
that neither their couple nor themselves were ready to
have the baby. They had their own jobs to focus on. In
addition, family planning was also one of the reasons that
two participants mentioned. One participant indicated that
abortion was done following the failure of contraception.
Some other reasons were also offered. For instance, the
fetus died in the uterus; the family fell into crisis during
142
the time of pregnancy and the pregnancy affected the
health of mother and child.
Methods, places for abortion and stakeholders in aborting
decision
From the findings, the majority of the respondents
who chose to have an abortion went for medical surgery.
The percentage indicated that 8 amongst 14 pregnant
women have had surgical abortion services before. Two
persons answered they bought abortion medicines from
the pharmacy while one person said she received the
abortion medicine from a doctor she went to consult with.
Three persons did not respond to the question. On the
top of that, none of the Cambodian women in Phnom
Penh admitted to having drunk any traditional Khmer
medicine to abort the fetus. This choice corresponds to
the question of where the abortion took place. Amongst
the three choices, private hospitals ranked number one
with 10 persons having had the service there compared
to the other two locations, public hospital and illegal
abortion house. Only one participant went to have the
service at public hospital. There was an extreme case of
this participant that she practiced abortion at home by
purchasing the abortion medicine. Since abortion at
home was not successful, she went to a private hospital
to do the followed-up procedure to ensure that abortion
was properly completed at last.
Do Cambodian urban women make their own
decisions on abortion matter if women are said to have
the full rights on her own body including the rights to
abort the fetus while at the same time considering it as a
moral act? The question being asked was, “whom do you
consult with to make the decision to abort the
embryo/fetus?” and five choices were offered including
husband,
parents/parents-in-law,
friends,
midwives/doctors, and self-made decision. The result
presented an independent figure that women had the
discussion with their husband (9/14 persons). 3 women
out of 14 also sought discussion with their parents or
parents-in-law. Midwives and doctors were met and
discussed by 5 pregnant women before abortion was
carried out.
Figure 3: Percentage of feeling towards abortion in
general among the respondents
Figure 3 shows the percentage of how the
respondents felt toward the practice of abortion in
general. The result was concluded from both male and
female perspectives of over all samples. More than half
of the respondents regarded that abortion was strongly
unethical, which accounted for 53%. Eighteen percent of
the respondents viewed abortion as moderately
unethical. Nevertheless, about 14% could accept
abortion or thought it is ok to carry abortion. On the other
hand, 3% said it was strongly unethical, and 1%
moderately unethical. 12% of the respondents did not
answer this question.
Moral circumstances and views on abortion
As the findings showed, the conditions in which
abortion could be morally acceptable from the total
respondents were asked. The result illustrated that 14%
of the respondents conveyed their views on the abortion
matter as “morally acceptable if parents do not want the
baby regardless of whatever reasons.” However, the
percentage that considered abortion is acceptable went
as high as 50% if it affects the health of mother and the
fetus is disabled. With quite a significant figure, 22% of
the respondents protested that abortion is unacceptable
and should not be practiced regardless of whatever
reasons. The rest of the percentages shared 8% to no
comments and 6% to other reasons such as being raped,
having insufficient ability to bring up the children, poor
family situation and having too many children. Likewise,
in case that pregnant woman is in emergency case
where abortion is necessarily required, abortion could be
“morally accepted”.
Additionally, participants were asked to use one
word or a phrase to describe abortion. The word could be
an adjective, noun or any part of speech. The vast
majority of the words offered are negative adjectives
including: unethical (15 persons), immoral (5 persons),
irresponsible (4 persons), bad (3 persons), cruel (3
persons), frightening (2 persons), selfish (2 persons),
suffering (2 persons), inappropriate (1 person), and
strongly unethical (1 person). There are several positive
adjectives used to describe abortion such as: appropriate
(1 person), logical (1 person), ethical [based on living
factor] (1 person). Some more negative noun and phrase
were killing (4 persons), circumstance (3 persons), sin (3
persons), health affected (2 persons), breaking the law (1
person), complicated situation (1 person), crime (1
person), dangerous act (1 person), fault (1 person), and
serious mistake (1). 26 participants did not make
comments. (The number in the brackets is the number of
persons who mentioned each term).
Sex-selective
abortion
aspect
from
medical
personals
Concept of sex selection and legal conditions for abortion
in Phnom Penh
Both midwives consistently said that there is no
mention about sex selection in the medical field from a
[Cambodian] national stance. The first midwife
addressed, “In a national stance, abortion is not done for
couple’s desire on certain sex on their baby.”
Addressing about sex selection abortion, both
midwives expressed their views on the issue. Neither of
them supported the idea in a broad sense except the
critical case that the fetus is growing abnormally.
“Abortion is not stated to fulfill the desire on the gender of
your baby”, the first midwife claimed. On the contrary, the
notion of sex-selective abortion is asserted to exist in
distinctive conditions from the experiences of the two
midwives. Surprisingly, the first midwife revealed that
there are sophisticated individuals who would come to
seek the [sex-selective abortion] service from doctors. A
different view from the second midwives is sex selective
abortion normally took place when couples already had
one or several children of one particular sex and wished
to have the opposite.
In both interviews, the midwives mentioned that the
abortion law was promulgated in 1997 and the Prakas
(announcement) on abortion was passed in 2002. There
were particular conditions in which abortion is allowed.
Three conditions were captured into discussion. The
first one was in the case that the woman was victimized
from rape and it is a shame to conceive because
Cambodia is a conservative country and has strict
traditional rules. The second case was that the fetus was
diagnosed to be physically insufficient; therefore, the
Ministry of Health and Science, in the case, would
approve the woman to perform abortion with her consent.
The last case was the worsening health situation of the
mother if she kept the fetus. If the examinations were
found out to be unfavorable to a woman or threatened
her life, then abortion would be highly likely to be
adopted. In addition to the conditions, termination is
allowed of the first trimester intrauterine pregnancy (up to
3 months). According to article 8 of the Kram on abortion,
“abortion may only be carried out for those fetus that are
under 12 weeks old.” However, there were cases that
abortion could be still performed until 20 weeks (5
months) if the reasons fell among the reasons specified
earlier. The medical personal would remind and explain
about the risks as well as confirmed about the aborting
decision before abortion really took place.
Is sex selection a myth?
Surprisingly, the first midwife said she has never
heard about “sex selection”. When mentioning about
gender-driven abortion, the first midwife reactively said,
“Abortion is not used for sex selection purpose; it is a
necessity for couples to understand this point”. Sex
selection is a “rumor” in Phnom Penh according to the
first midwife. She addressed two main sources of the
rumor. Firstly, it is based on scientific arguments. “It says
nothing about how to get the baby as you want; No one
could assign the gene and chromosomes in our bodies.
Girls have X and boys have XY. And when they have
sexual intercourse, it depends on chromosomes only for
which spermatozoid is stronger. This is the way it works.”
Secondly, she drew the attention to the sayings
mentioned in Chinese books and traditions. Some
sayings such as the practice of sleeping on the left or
right to get a baby girl or a baby boy as well as sleeping
according to hot and cold weather were addressed. “All
of these beliefs come from China”, believed the midwife.
In addition, there had been no concrete records or
methods to conceive the baby with the gender that we
want. Nevertheless, she pointed that there were people
who sought advices on fetus gender matter with doctors
although the doctors also had no ideas.
However, the second midwife claimed that she used
to know about a table that could predict gender of the
offspring depending on several parameters such as the
age of parents and the month and date of intercourse
(This refers to the Chinese table discussed in the
introduction).
143
Gender preference amongst Cambodia and SinoCambodia
The first mid-wife said that there were “no cases” of
gender preference in Phnom Penh or Cambodia.
Comments were made on the so-called “son preference
to sustain family line and property division after passing
away being divided to sons only, not daughters”, in the
Chinese case. Conversely, in Cambodia, it was said to
“have no such [son] preference”, claimed the mid-wife.
She said, “Cambodia is completely opposite to China.
Indigenous Cambodian do not care about family line”, as
mentioned, “we have never talked about family line”.
Indigenous Cambodian would rather be concerned about
living with comfort than the gender. Moreover, if the first
child was a daughter, then she could help with household
chores, as she grew big faster. She reported that she had
heard cases where Sino-Cambodian was said to have a
wish for sons to sustain the family line. “They will try
whatever means to have one [son]”, said the midwife.
The second midwife tended to believe that either
sons or daughters are naturally life itself. She addressed
no comments on the point.
Abortion methods, abortion safety and its drawbacks
From the interview, there are many types of abortion
methods being used in Phnom Penh according to the first
midwife. However, the two main types are medical
abortion using pills and surgical abortion using
instruments. There are different types of surgical abortion
either by electric means, hands, rubber syringes and
metal instruments. Surgical abortion refers to “cleaning
the blood (fetus)”. Regarding abortion safety, abortion is
not 100% “sure”. In other words, risks shall be still
carried. However, those who sought for proper abortion
service from medical practitioners under authorization of
Ministry of Health carried smaller risky chance compared
to women who sought the service from “secret places”.
According to a voice recording from a health
program on women health called “Beauty and Women’s
Health” at South East Asia Television, Cambodia on 12
June 2012, Dr. Kong Phannary, the deputy chief of the
department of Obstetrics introduced about the
disadvantages of abortion using instruments and medical
abortion using pills. In her presentation, she pinpointed
that abortion using instruments causes three main
problems: bleeding, causing reproductive illness and
womb wounding.
She further discussed in details about the two major
disadvantages of medical abortion using pills. “The first
disadvantage is that when there is excessive umbilical
cord left after using the pills, constant bleeding occurs”,
said Dr. Kong. She continued, “The second disadvantage
is based on scientific conditions on abortion pills that if
the fetus is not aborted after the mother takes the pills,
then thorough cleaning [on the blood] is needed or the
fetus will grow abnormally which results in physically
insufficient or brain damage.”
Dr. Kong emphasized repeatedly to encourage
women to seek abortion service from medical
professionals who received proper training on the field in
order to minimize the risks. “Admittedly, there were a lot
of scientific conditions in women’s body that is
unpredictable. Cambodia did not have enough
researches as well as medical equipment yet”, she
presented. It is advisable and essential for women that
144
they will receive a thorough explanation on how to use
the pills and that they will be counseled on her abortion
choice. “Abortion is safe if women seek the service from
medical personals who receive proper training. Women
face very
least drawback”, said Dr. Kong.
Notwithstanding, women prefer buying pills because “it is
private and can be done secretly to hide from neighbors
and friends.”
The second midwife demonstrated a very consistent
point regarding the counseling service offered to
abortion-intended women. She added that, “Women are
required to rest at the hospital after she decided to abort
the fetus that is or more than 12 weeks.”
Pluses and minuses over abortion and its service in
Cambodian society
Abortion is not always attached to a negative
impression. There are pluses associated to abortion
brought to those who underwent the service. Three
advantages were reviewed during the interview with the
first midwife. To begin with, the midwife said, “Abortion
avoids shame and confrontation of conceiving a child out
of wedlock.” This is also linked to the case of being
raped. Cambodian people possess a very strict norm on
marital status and marriage life. Women are subject to
strict social criticisms, which sometimes cause suicide.
Moreover, such infant termination functions as “keeping
the pot boils” – ensuring the social status of those living,
the family and mother. For instance, some women were
so-called “beer girls” or sex workers. In order to maintain
the job, she has only the choice of carrying out an
abortion to avoid being dismissed from current job.
Lastly, abortion could be a means to fulfill the couple’s
desire at the moment that they do not want the baby,
which falls out of their family planning. To an extreme, it
might be an alternative for those who care about gender
of the baby to meet up with their desire. “These
advantages should not be overlooked”, proposed the
midwife.
On the other hand, every plus has a minus. There
are several disadvantages that normally would be
magnified by the society. Obviously, these minuses
should not be unheeded. To illustrate, the midwife
complained, “Limited transparency of abortion service
could be one of the minuses”. Cambodian people
addressed “abortion as killing life” or in a technical term
called “infanticide”. Therefore, even the hospital could not
promote the advertisement of abortion service offered
legally and protectively by the National Maternal and
Children Health center.
“The ads for proper abortion service were finished
ages ago, but it has never been broadcasted as it is
strongly against the social image of the Khmer”, the
midwife pointed out the operations on promoting abortion
service. This resulted in many women seeking for
abortion service secretly in private clinics or illegal
aborting houses, causing substantial reproductive health
issues such as getting chronic disease on reproductive
organs, which triggered later infertility. In a serious case,
abortion caused death. Additionally, abortion is against
local religious and well-preserved beliefs. Sin is attached
with a person whether in the present life or to next life if
one kills a living being in Buddhism. Abortion kills life.
Therefore, abortion is sin. This argument caused women
who used to abort to carry guilt throughout her entire life.
Women are typically considered as a “murderer”.
The second midwife criticized the abortion service
offered by private clinics due to privacy concerns for the
women themselves. “Abortion is loosely practiced in
private clinics for money reason”, answered the second
midwife from the telephone.
Ethical views on sex-selective abortion
“It is unreasonable for those who think so [sexselective abortion]. It is a ‘one-head’ decision of oneself.
This is inappropriate, cruel, and very stereotyping”,
proposed the first midwife when asking about her own
ethical views toward sex-selective abortion. She
rationalized as followed. This reflected the same thought
as participants who responded to the questionnaire, the
answer was “They are our children, either boys or girls,
we already conceive them.” She advised couples that
long for determining the gender of their children by
seeking for real and reliable information. Meanwhile, they
have to seek enough evidences that the information is
practical. On the top of this, she warned the potential
problems abortion would cause. She ironically compared
a women’s womb to “coconut shield”. “It [womb] is not as
hard as coconut shield which you could perform many
abortion as you want just to get the fetus of the gender
you want.” In this regard, women were put and/or put
themselves at risks and threats over their own health.
The second midwife shared similar views.
Concurrently, she is working for the delivery department.
When asking the reason why she does not want to work
for the abortion department, she said, “I was asked to
receive further training on the abortion, yet I decided not
to go as I am doing merits (in Buddhism).”
Additional comments
Some additional comments were offered between
the “ethical abortion case” and “purposeful killing” by the
first midwife. To elaborate, if the fetus came accidentally
out of family planning, the couples decided to abort the
fetus since it was very small, then abortion is acceptable.
However, if the abortion is done after realizing the gender
of the fetus, then the act became “purposeful killing”. To
avoid abortion, the midwife talked about the importance
of contraception. “I don't encourage conceiving and then
aborting later”, she said. Contraception shall be a very
crucial component of family planning. If couples eager for
either a son or a daughter, then they should seek for
proper consultancy service even if abroad. When made
aware of sperm sorting, the midwife saw some
advantages. Sperm sorting could be an alternative to
achieve the need although it costs an arm and a leg. The
midwife supported the sperm sorting method, “I support
sperm sorting as it meets with the expectation of those
who eagerly want sons. It is good; no problem. Only that
the current financial situation of Cambodian population
still finds it hard to afford.”
On behalf of a health profession and as an elder
Buddhist, the second midwife discouraged sex selective
abortion. She stated, “ we should know that if we do not
ant the child, we had better use contraception at once.
[…] Naturally, life already started when we conceived,
either boys or girls, they are all our children.”
Sharing the same ethical principle, Dr. Kong, after
explaining in details about the disadvantages of various
abortion methods, advised women to apply the family
planning methods by using contraception if the couples
opt not to have any children. Furthermore, if abortion was
considered one should terminate as early as possible to
avoid risks.
7. Discussion
As can be seen from the above findings, sex
selection has not become a concern yet in Cambodian
society although there might be small proportion of the
population expressing son preference. The case does
not happen out of the expectations, as Cambodia is a
matriarchal society in theory and patriarchal-based one in
reality. This consistently corresponds to the result of the
need for a balanced gender amongst male and female
infants. Nevertheless, we are going to examine sex
selection issue from distinctive grounds mirrored from
biological, socio-economical and religious aspects. We
shall also examine the feminine and masculine notion, as
well as matriarchal and patriarchal pattern.
Biologically, reproduction continues the human
species through its biological process by which new
offspring individual organisms are produced from their
parents. No human intervention interferes in the process
of reproducing procedures. It is sex chromosomes, X and
Y that determine the gender of the offspring. This is
called natural selection in reproduction; it is random that
a particular sperm makes it to an egg before the others.
This primary form of natural selection shows no gender
discrimination at all. Instead, it is a matter of “dice”. More
or less, “the rolling dice” phenomenon allowed a roughly
fair chance of the sex ratio. In other word, the sex ratio is
50:50 which means about as many girls as boys. One
might argue that people whose children are all of one sex
are playing with “loaded dice”. A different view is the
bioethical value of autonomy. Humans have autonomy.
Both male or female are human. Thus, either male or
female beings can have equivalent autonomy. This
argument displays no gender segregation at all. It is true
that sex selection interferes in nature and autonomy of an
individual. As reflected from the findings in urban districts
in Cambodia, sons and daughters shall be equally loved,
as it is “nature” and nature shall not be controlled.
Socially constructed gender roles wash away the
supreme idea of the natural equality between the two
sexes. When the fetus arrives to the earth, they will be
automatically tied to specific roles and certain social
expectations. Just as the completed finding shows, sons
and daughters shine different hopes to the family.
Women tend to be captured and stigmatized in more
nursing roles while men fulfill the role of being the master
of the family. The question is where is the equal
autonomy between the two social constructed roles of
certain sex? Who assigns such stereotyping social roles?
If the answer is the culture, then who creates the culture?
Humans create culture. Humans are male and female.
Thus, male and female create culture. Obviously, it is
ironic to say females choose the nursing job for herself
and fix it on the head of herself and pass the “duties”
from generation to generation.
In the Cambodian context, sex is traditionally
associated to particular traditions, expectations and
norms. As can be seen from the main finding section that
a large majority of participants stated that daughters are
committed to the so-called “gender oriented tasks” such
145
as helping with household chores, nursing younger
siblings, taking good care of parents when they get older.
This figure has drawn our attention to look into the aspect
of the decision making process that couples undergo
before abortion choice is made. As the data shows,
women have to “have a talk” with their husband.
Certainly, they possess no full rights to make decision on
her body – the only private possession she has. This
aspect might appear to be normal and logical as it
happens in many countries around the world.
Nevertheless, women’s self-decision-making rights,
admittedly, are overwhelmingly suppressed and
subconsciously
withdrawn.
Admittedly,
women
themselves, as time passes by, take the issue for granted
and accept the appointed submissive role in the family
and society. For instance, women in Cambodia are
obliged to study the Cambodian Lady codes of conduct,
which advises women how to behave as a proper single
lady, a good wife, a responsible mother and a great
daughter-in-law. There are many articles that violate the
rights of women although the code of conduct initial aims
for a proper and fair upbringing of women to be a
“standard”. For example, a good lady is the lady who
speaks less and listens to every word of her husband.
Even if an argument occurs, women are the party who is
supposed to surrender and never “get back” to avoid the
fragility of the family bond.
One could also say that it took decades for societies
in the West to give women equal rights and pass
women’s suffrage laws. Looking at why those changes
were made, it becomes obvious that women’s
contribution to the workforce runs parallel to their
ownership in the decision making of their society. When
women are viewed as an indispensable part of the labour
force, it follows that they are able to make demands that
might otherwise be ignored. While we can learn from
examples abroad, the situation here is somewhat
different and, one might think, even more promising.
Another way to view is that women are restricted from the
basic expressing rights and are put under enormous
criticism and discrimination. The midwife pinpointed the
absence of abortion education to seek proper services
and the pressure the society charges against women as
“killers” which push women to preserve her privacy by
taking up abortion service in private places without
authorized skills. One assumption is the danger that
women are put, or put themselves at risk in term of health
and welfare.
As mentioned, Cambodia is a matriarchal-based
society. This is probably the reason why the percentage
of those who want daughters are still high and is
considered balanced to that of sons. Throughout history,
in the memory of Queen Lieu Ye’s matriarchy, the first
royal queen of the kingdom of Cambodia, the word mae
(mother) continues to connote the honor of the femalebeings and, more importantly, traits of ‘greatness,
leadership, or of being the essential elements. For
example, gender-neutral words such as mae-khum (chief
of commune), mae-torp (military commander) are used to
refer to anyone who holds the power of these positions. It
is also worth noting that Cambodian people address
parents and grandparents by saying female first,
frequently “mother and father” and “grandma and
grandpa”. For this reason, matriarchal foundations are
laid out on a grass-root basis. Nevertheless, it seems that
146
the reality of present Cambodia contrarily pictures a
patriarchal based society.
There rises a situation that there are only few
women who hold top positions in the government, NGO,
as well as private sector. In current state of affairs, there
are three important female figures. One is deputy prime
minister, Men Sam An, the second one is Minster of
Women’s Affair, Ing Kantha Phavi and the opposition
party member Mu Sochea. Rewardingly, economic
independency would play a significant role in determining
women’s status and the positivity of people on conceiving
a baby girl. Strong financial capability might be able to
alter the perception of the social norm on son preference
although it takes time. At the challenging end, the desire
to benefit from economic benefits offered by the
advancement that is available in today’s world seem to
put more growing pains and pressure in women to
pursue ultimate success. Women still face countless
barriers in order to access the top stratum of power
brokers in a country regardless of the merit of their
wisdom. It is crucial to understand that these contrasting
realms helplessly influence, more or less, on the
perceptions of parents to picking up particular sex. In
other words, if sons and daughters show the same
capability in economic independency, then it might not be
a concern anymore for either having a son or a daughter.
This sort of argument resembles to the notion of the
Cambodian mindset in term of “living with comfort”.
Is sex a disease? Macer (2000), wrote “sex is not a
disease anymore than life itself, but a phenotype, it
continues to be a reason used in practice for prenatal
diagnosis and selective abortion?” (p.113). Can the
society allow the individual to have free choice on sex
selective method with non-medical reasons? In the
utilitarian approach, the view is generally held to be one
that morally right action is the action that produces the
most good. The approach rooted in the idea that ethical
actions are judged based on the consequences, not the
intentions. Hence, it could be argued that sex selection is
not utilitarian. To justify, sex selective methods for nonmedical reasons enable sex-selected oriented parents to
fulfill their hope and be happier. This first argument can
be traced back to self-interest at the expense of
humanity’s long-term interest, at the worst, the mention of
imbalance sex ratio. The second argument is that sex
selection involves the justification on family balancing.
Families that already have one or more children of one
sex may want to select the gender of their next child to
“balance” the gender ratio of “offspring”. Bio-ethically, the
presence of autonomy is absent from this type of
argument. According to rights-based approach, every
human has dignity that is based on their human nature.
They should not be treated as an end, and not merely as
means to other ends. Each child, either boys or girls, has
their own dignity to be preserved. In this respect, using
another child as the fulfillment of parents’ intention is a
violation of the primary dignity of the child. On a whole,
should certain types of sex selection method being
practiced? The answer could be varying among
individual.
According to data in figure 3, the overall impression
of the respondents indicates that three fourths of the
participants think that sex selective abortion is unethical.
The indicating figure depicts a clear mindset of the
Cambodians toward ethical concerns towards sex
selection. Abortion is acceptable merely in the case that
the fetus is disabled and they affect the mother’s health;
this circumstance passed fifty percent of the majority
vote. Concurrently, the midwife expressed supports to
any methods that minimize the harms on women and the
offspring compared abortion. As a whole, careful
discussion on ethical issue shall be thoroughly raised the
related potential concerns towards sex selective practice.
Unlike Cambodia that there is no concrete indication
about sex selection orientation, countries like China,
Vietnam, and India have encountered severe cases of
sex selective abortion. This is due to the cultural
imbalanced values between the two sexes. In the
aforementioned countries where boys are highly prized
for economic, hereditary, religious and cultural reasons,
apparently, it is more than impossible to reconstruct the
gender value. As a Hindu saying puts, “raising a daughter
is like watering your neighbors’ garden” since a girl is
deemed to have joined her husband’s family on marriage.
Indian parents are scared of paying the abundant dowry
to the groom’s family that they have to abandon the
thought of having a daughter. Chinese parents are under
the pressure of the one-child policy and the notion of
sustaining the family line. Vietnamese parents have son
preference due to similar conditions as in China. At the
worst, there are stories abounding of Vietnamese bride
abduction, the trafficking of women, rape as well as
prostitution. Are women commodities? What could be an
alternative to “brainwash” the deep-rooted stereotyping
notions associated to sex? Could modernization
empower changes?
8. Conclusion
To sum up, sex selection is a complex topic. In
patriarchal based societies where the cultural and
economical value of sons is at a premium, daughters are
distorted to even face extreme cruel acts of female
infanticide. Some parents attempt to terminate the
existence or presence of the girl fetus from using the
advanced technology to pick the gender prior to
conceiving, carrying-out abortion during pregnancy and
lastly gendercide after a baby girl is born. As the findings
revealed, although sex selection is a major ethical
concern in many countries, there is no clear-cut
indication shadowing sex selective orientation in the
urban arena in Cambodia in the present time although
the rank of the fetus itself matters respectively.
The population of Sino-Cambodian also showed no
gender preference except that indigenous Cambodian
expressed labeled views on Sino-Cambodians that they
have gender preference. The cultural values associated
with each sex have taught the importance of sons and
daughters presence in a family although there is plenty
bias toward females in lady code of conduct. This core
value is well preserved by passing through generations.
The result in this research study signifies positive
cultural, moral and ethical values of the Cambodian
people reflecting from biological, socio-economical and
religious points of view. However, since the result of this
first research conducted on sex selection issue in
Cambodia was grounded on very limited sample sizes,
interviewees, as well as limited resources, it is advisable
to have future research conducted fundamentally on this
research.
Appendix 1: The Chinese Conception Chart/ The Chinese Gender Chart
This chart is used by matching the woman’s age with the month of the baby’s conception or using it to tell which
month will be a good month to try for a boy or a girl. MOC stands for Month of Conception. The number in the
horizontal signifies the age of women. F stands for Female and M stands for male.
Source: Retrieved on January 11, 2011 from www.hcmionline.com/education/know_your_babys_sex.pdf
Qualitative research is highly recommended to
comprehensively explore the perception of those
whoever performed sex selective abortion (if any).
20
22
Appendix 2: Full Comments for Question 14 (No
preferences)
24
Note: Those responses without a comment are omitted from the Table.
The Coding Scheme
1: They are my children; we love them.
2: People have same value.
3: Equal Human Rights
4: Function is different
5: Self-realization/ Education is important
6: Same ability/ capacity
7: As long as they are healthy
8: Should not control nature
9: Not stated
ID
2
3
4
5
6
7
8
9
11
12
14
17
18
Comment
They are our children, either male or female.
They have the same value.
They are our children. The daughters today are
not less capable than sons. It doesn’t matter with
gender, but the children themselves, which make
them a good child.
I can’t decide on gender of my child. It does not
matter with gender as long as they are healthy
and good children.
They come naturally. Both sons and daughters
are socially accepted. It is a matter of healthiness
and being obedience.
They are all my children.
I love both of my children equally.
It is not crucial for me with the gender of my
baby, either boys or girls. They are all my
children and have the same capacity and value in
the society. They would become good persons as
long as they receive proper education.
They are all my children. I don’t mind having
either boys or girls.
It is natural.
Boys are my children. Girls are also my children.
Either boys or girls are our children, which
represents love and happiness in the family.
It doesn’t matter either they are girls or boys.
26
27
28
category
1, 2
30
1, 5, 6
31
32
33
1, 7
34
35
37
38
39
2, 7, 8, 9
1
1
1, 2, 5
40
41
42
1, 8
1
1
43
49
50
53
55
56
1
1
59
62
1
I love both gender. I want both sons and
daughters. My husband has the same thought as
me.
Boy can do hard work; girl can help in the house.
[Different function]
Sons and daughters are all having flesh and
brain. They could study and work on different
tasks.
Gender doesn’t matter much in the family.
It is us who gave birth to the children, either boys
or girls. We have to take good care of them both
physically and emotionally especially giving equal
education to them. Both sons and daughters
could help do housework. They could sustain the
family line, go to work abroad in order to feed the
family and look after parents.
They are all my children and they deserved equal
treatment.
It is difficult to have the child as our desired wish.
As long as they are healthy and clever, it doesn’t
matter with gender at all.
Because they are our children.
I have no child yet.
Girls or boys are all our children. I gave birth to
them, so I love them.
I love my children.
I equally love my children.
Since they are my children, I love them all
regardless of their gender.
They are all my children. Both boys and girls
could help parents’ tasks.
[Gender is not important] as long as they are
healthy and are not handicapped. I don't care
about gender, but I get 2 children only.
Natural. As long as they are healthy.
I love my children regardless of their gender.
They are all my children, either boys or girls.
It is all the same, either boys or girls. They have
the same rights.
They are all human. They are my children.
Daughters could help do housework and other
1
4
2, 4
1
1, 5, 6
1, 3
1, 7, 8
1
9
1
1
1
1
1
1
1, 6
1
1, 7
7, 8
1
1
1
1
1, 3
1, 3
4
148
tasks as well as doing small business. They are
more obedience but they can’t handle hard work
and go further from house. Also, girls received
more pressure and being shameful than boys
when they are problem. However, they won’t give
up parents.
On the other hand, sons could go further from
home, work on hard-labour work instead of
parents. Still, they don't listen to parents’ advice
much. The most important point is son is the one
who sustain the family line. Even if they are
spoiled or commit wrongly, boys are viewed as
“gold”.
Anyway, it is better to have both sons and
daughters.
63
I love both sons and daughters. Both wants to
live. I can’t practice infanticide. There needs to be
balance gender ratio between sons and
daughters, so that they could build and develop
the country for the better happiness in the future.
They are all my children. It depends on how we
educate them.
I love my children.
Since I already gave birth to them, I love them. I
will never abort the fetus.
As a Cambodian, I think there is no gender
preference. It is a simple matter and it should not
be chosen as long as the child is grateful.
Only the rich who are busy with their business
that they want to have boys than girls, so that
they could sustain their family line.
I equally love them.
It doesn’t matter with gender at all. What matter is
whether children are grateful and they walk on
the right paths.
64
66
67
68
70
71
75
76
27
28
45
46
1, 3, 4, 9
47
58
1, 5
59
1
1, 9
62
1, 9
4
1
1, 5, 9
64
1
Additional Comments at the End of Questionnaire
Note: Those responses without a comment are omitted from the Table.
68
ID
Comments
8
On behalf of being parents, we should be fully
responsible for bringing up children. We should have
proper family planning in term of conceiving baby and
educating them. If we want to abort fetus, we should
consult with medical expertise in order to avoid harmful
effect on our health and cause danger to life.
Abortion is a very crucial issue within family. Careful
consideration is needed before aborting decision. If the
reasons are not crucial enough (e.g. affecting mother
and children), abortion shall not be practiced.
Contraception shall be effectively used if having no
desire for children.
Please take measurement to stop studying female
teens who break Khmer tradition and customs. It can be
observed that abortion is widely practiced amongst
female high school and university students nowadays.
The number keeps increasing which affects the health
of mother. More importantly, the act devalues Khmer
society ethics
To be high responsible parents, we need to have clear
consideration before we decide to do something.
Abortion is an action that we don't response to what we
have done. If we don’t want the child, why don’t we use
condom to protect unexpected child? The tiger never
eats its child, but if you have decided to abort your
baby, this means you are very bad than tiger that is a
wild animal living in the forest.
In my opinion, abortion is acceptable only in case that
the fetus is diagnosed to be disabled.
Abortion is inappropriate because it harms mother and
child’s health. It can lead to serious danger on
reproductive health of the mother if she wishes to have
baby in the future. Therefore, it is advisable that if we
haven’t well prepared to take up mother’s role, please
go to consult with doctors for advises.
If I were healthy during that time, I wouldn’t have
aborted my baby. Simply because I pity them.
13
14
16
21
24
25
70
72
76
Last of all, on behalf of being a mother, I would like to
say this questionnaire offers advantages and is very
crucial for reproductive life. We should discuss with our
husband to avoid conceiving incidentally since it is hard
to abort. Abortion could danger mother’s life and it kills
an innocent life. Abortion causes sins for the future.
We have to ensure that the fetus is wanted, not
conceived incidentally since abortion not only harms
our heath, but also affects our phycology.
In my opinion, abortion should not be practiced since it
proves that we are irresponsible person; we can’t
confront with what we have done. We kill innocent life.
My husband and I are civil servants. We have little
salary and we already have two children. Therefore, I
decided to abort the fetus since I could not afford to
offer all the needs. I am afraid I could not bring the two
children up very well and offer them good education.
We must have family’s planning properly.
We can’t say who is right and who is wrong. It is a
matter of acceptance and decision if a person could
confront on what is happening.
Both sons and daughters have their own strengths as
long as we, as parents, properly educate them.
At first, I want to have only daughters. Later, when I had
daughters, I think I should have sons also. The reason
is that I could ask for help from one child if the other is
not grateful. Regarding my abortion in 2009, it causes
me a lot of health problems. First, I have to go to clean
the blood left again and again (medicine, clinic, and
public hospital). Shortly 3 months after, I conceived
another baby, which I have no time to take good care of
myself. I have womb-related illness and my health are
weak until now.
I could see that the abortion rate keeps increasing year
to year. However, not all abortion is inappropriate. We
have to examine the mother’s health factor is suitable to
conceive baby or not. Some mothers can’t since their
health is weak or they have other diseases. Some
mothers abort for the reason that they don’t want. This
is a serious mistake since a mother kills their own
innocent baby by themselves.
This questionnaires lead to careful reconsideration for
people to be responsive to what is happening in their
family.
I want to add that in every family, we should understand
clearly and decide if we want to have bay or use
contraception. This concerns as it affects the health of
mother and family greatly.
Abortion equals to killing life. According to religion, it is
very sinful.
In my opinion, although the abortion rate keeps
increasing, the purposeful abortion in regard that we
don't want the fetus is wrong as we kill our child on
purpose and it causes us health-related issue.
Sometimes, we can’t even conceive in the future.
Appendix 3: Translation of Questionnaire
Note: Formating was difference.
My name is Kouy BunRong. I am a recent graduate of Institute
of Foreign Languages, Royal University of Phnom Penh. I am
conducting a research on a topic “Infant’s Sex Selection: An
ethical lens through a city focus” for part of a UNESCO
study.
This is a quantitative research study. This research is being
conducted to understand the perceptions of parents and
medical expertise regarding their ethical value toward sex
selection which leads to female (and male) feticide and
sometimes even infanticide. I would like to invite your valuable
participation in this noticeable study.
Your time, honesty and input are greatly appreciated. Thank
you very much.
Please beware of the following points.
1. Your participation is voluntary.
2. All the information you provide will be strictly confidential. No one
can access to the information beside me, as a researcher, unless
receiving your approval.
Instructions:
1. Please read these instructions carefully. In case you do not know
how to read, there will be someone from our surveyors who helps you
read out the questions.
2. Please complete the questionnaires individually without discussion
with anyone. There are 21 questions in total.
3. Please circle, tick or write down the answers according to the
questions.
4. Read the statement carefully and decide how you feel about it.
5. There are no “right” or “wrong” answers. Therefore, do NOT try to
guess the answers.
6. Do not spend too much time on any single question. Your
immediate and honest reaction response is highly appreciated.
7. If you feel uncomfortable with any questions, feel free to leave it
blank. Do NOT try to give any misleading answers, as this would affect
the result of the study.
8. If you choose the wrong answer and wish to make correction,
clearly cross out the mistaken one. Then circle/tick the new one.
9. There are some questions which you can provide two or more
answers. Therefore, read the questions carefully.
10. There are some technical words. Please ask the surveyor if you are
not sure.
11. There is space provided at the end for any additional comments
you would like to make about these questions.
If you have any questions regarding the research study or require
greater details on how this information will be used, please do not
hesitate to ask the surveyors, or contact me directly at HP: 012 606 456
or by email at [email protected] / [email protected]
I. General information
1. Please indicate your district.
☐ a. Chamkar Mon
☐b. Duon Penh
☐c. Prampir Meakkara
☐ d. Tuol Kork
☐e. Dang Kuo
☐f. Sen Sok
☐ g. Meanchey
☐h. Russei Kaev
2. Please indicate your gender.
☐ a. Male
☐
b. Female
3. Please indicate your age. Please write the number on the line
provided.
_________________________________________________________
4. Which one of the answers below indicates you?
a. Indigenous Khmer
b. Sino-Khmer
c. Muslim-Khmer
d.
Others
___________________
5. Where is your hometown? Please write on the line provided.
_________________________________________________________
6. What is your job? Please write on the line provided.
_________________________________________________________
7. How much is your monthly income?
a. below US250$
b. US250$-US500$
c. US500$-US750$
d. US750$-US1,000$
e. more than US1,000$
8. How many years have you got married? Please write the answer on
the line provided.
________________________________________________________
9. How many children do you have?
a. 1
b. 2
c. 3
d. 4
e. More than 4
10. How many boys and how many girls? Please write the number on
the line provided. If the answer is zero, write 0.
a. ______ Boy(s)
b. ______ Girl(s)
II. Perceptions on sex selection
11. Do you prefer sons or daughters? Please tick (✓) in the box. If you
tick a, go to questions number 12. If you tick b, go to question number
13. If your tick c, go to question 14.
☐a. Sons
☐b. Daughters
☐C. No preference
12. Why do you prefer sons than daughters? (Tick all that apply)
a. Your husband/wife and family want a son(s).
b. Sons are easier to bring up.
c. To keep the family line.
d. Sons could go far from home to earn money.
e.
Other
reasons.
______________________________________________
13. Why do you prefer daughters than sons? (Tick all that apply)
149
a. Your husband/wife and family want a daughter(s).
b. Girls are easier to bring up.
c. Girls can help household tasks.
d. Girls would care the parents at their old age.
e. Other
reasons.
_____________________________________________
14. Why do you have no preference between sons and daughters?
Please write down your answers. The reasons can be more than one.
Reason 1: ______________________________________________
Reason 2: ______________________________________________
Reason 3: _______________________________________________
Reason
4:
_______________________________________________
III. Abortion
15. Have you ever aborted any fetus? If no, go to question 20.
☐ Yes
☐
No
16. Why did you decide to abort the fetus? You can choose more than
one answer.
a. Because it is a baby girl.
b. Because it is a baby boy.
c. Because I do not have enough financial support to bring it up.
d. Because my husband/wife and I are not ready to have baby. We
have our own jobs.
e. It is part of our family planning.
f. Contraception failed.
g. Others. _______________________________________________
17. What methods do you use to abort the fetus?
a. Drink traditional Khmer medicine
b. Surgery
c. Buy abortion medicines from pharmacy
d. Others. ______________________________________________
18. Who do you consult with to make the decision to abort the
embryo/fetus? You can choose more than one answer.
a. Husband/ wife
b. Parents/ Parents-in-law
c. Friends
d. Midwives/ Doctors
e. Self-made decision
f. Others. ______________________________________________
19. Where do you have abortion done?
a. Public hospital
b. Private hospital
c. Illegal abortion house
d. Others. ______________________________________________
20. How do you feel towards abortion in general? Please circle only
one box for this question
a. Strongly ethical
b. Moderately ethical
c. OK/ it is acceptable
d. Moderately unethical
e. Strongly unethical
IV. Views on abortion
21. Use one word to describe to abortion. The word can be adjective or
noun. Please write the word on the line provided.
_______________________________________________________
22. Under what conditions is abortion acceptable? You can circle for
more than one answer.
a. Abortion is morally acceptable if parents do NOT want the baby
regardless of whatever reasons.
b. Abortion is unacceptable and should not be practiced regardless of
whatever reasons.
c. Abortion is acceptable in case of disable baby and it affects a
mother’s health conditions.
d. Others. _____________________________________________
Additional comments:
Bibliography
Anonymous. (2010, March 04). Gendercide: The worldwide war
on baby girls. The Economist. Retrieved on April 24, 2012
from http://www.economist.com/node/15636231
Aghajanova, Lusine & Valdes, Cecilia T. (2012, February). Sex
selection for nonhealth-related reasons. American Medical
Association Journal of Ethics. Volume 14, Number 2.
Retrieved on May 7, 2012 from http://virtualmentor.amaassn.org/2012/02/ccas3-1202.html
Akchurin, Whitney & Kartzke, Ryan. (n.d). The ethics of gender
selection.
150
Chaipraditkul, Napat. (2010, November). Sex Selection in Asia
with a focus on Thailand. Eubios Journal of Asian and
International Bioethics. 20 (6). Pp.195-196
Chinese Birth Chart Organization. (n.d.) Chinese Conception
Chart.
Retrieved
on
May
4,
2012
from
http://chinesebirthchart.org/+&cd=9&hl=en&ct=clnk&client=fire
fox-a
Dickens, B.M. (2002). Can sex selection be ethically tolerated?
Journal of Medical Ethics. 28(6). Retrieved on January 10,
2012 from http://jme.bmj.com/content/28/6/335.full
Gammage, Jeff. (2011, June 21). Gender imbalance tilting the
world toward men. Inquirer. Retrieved on March 12, 2012
from
http://articles.philly.com/2011-0621/news/29683905_1_gender-imbalance-fertility-institutesboys
Grant, V.J. (2006, February 23). Sex predetermination and the
ethics of sex selection. Human Reproduction. Vol 21, No.7.
pp.1659-1661.
Gürtin, Zeynep (2012, April 23). The greatest gift. Research
Feature. UK: University of Cambridge. Retrieved on May 4,
2012 from http://www.cam.ac.uk/research/features/life-is-forsharing/
Haleem, Abdel M.A.S. (1993). Medical ethics in Islam. In
Grubb, Andrew (Ed.), Choices and decisions in health care
(pp.1-20). West Sussex: John Wiley & Sons Ltd
Johnson, Kay. (2007, November 02). Vietnamese girls go
missing. Time. Retrieved on March 12, 2012 from
http://www.time.com/time/world/article/0,8599,1680240,00.ht
ml#ixzz1os8fksMQ
Kevles DJ. Hood L, eds. (1992) The code of codes: scientific
and social issues in the human genome project. Cambridge
MA: Harvard University Press.
Kim, Clara. (2011, June 27). Poll: More Americans prefers
sons to daughters. Time. Retrieved on March 12, 2012 from
http://newsfeed.time.com/2011/06/27/poll-more-americansprefer-sons-to-daughters/
Lacono, Ilona Lo. (2012, February 21). The quest of the golden
dragon boy: Sex selection in Vietnam. Women’s views on
News.
Retrieved
on
May
7,
2012
from
http://www.womensviewsonnews.org/tag/vietnam/
Liao, S. Metthew. (2005). The ethics of using genetic
engineering for sex selection. J Med Ethics. 31 (2). Pp.116118
Macer, Darryl. (2000). What the genome project means for
society. In Ethical Challenges as we approach the end of the
human genome project. Christchurch: Eubios Ethics Institute.
Macer, Darryl. (2009). Effort to overcome sex selection in
reproduction in Asia. Journal of international Biotechnology
Law. Volum 6.
Markle, D.E. & Nam, C.B. (1971). Sex predetermination: Its
impact on fertility. Social Biology. 18 (1). Retrieved on
January
10,
2012
from
http://www.lawlink.nsw.gov.au/lrc.nsf/pages/dp11chp16
Malek, Janet & Daar, Judith. (2012, April). The case for a
parental duty to use preimplantation genetic diagnosis for
medical benefit. The American Journal of Bioethics. 12 (4).
McCarthy, David. (2001). Why sex selection should be legal.
Journal of Medical Ethics. 27. Pp.302-307
McDougall, R. (2004). Acting parentally: An argument against
sex selection. Journal of Medical Ethics. 31. 601-605
National Institute of Statistics, Directorate General for Health,
and ICF Macro, 2011. 2010 Cambodia Demographic and
Health Survey: Key Findings. Phnom Penh, Cambodia and
Calverton, Maryland, USA: Author
Nie, Jing-Bao. (2011, May 19). Non-medical sex-selective
abortion in China: Ethical and public policy issues in the
context of 40 million missing females. British Medical Bulletin,
98. Oxford University Press.
Popular
Magazine.
(2011,
December
21-31).
កម្ពុជា:
រំលូតកូនជាអំេ ពីស្របច្បាប់រឺេេ? Vol 18, Number 550. PP: Author.
SparkNotes Editors. (2003). SparkNote on The Good Earth.
Retrieved
January
12,
2012,
from
http://www.sparknotes.com/lit/goodearth/
Toebes, Brigit. (2008). Sex selection under international human
rights law. Medical Law International. 9 (3). Retrieved on
December
29,
2011
from
http://mli.sagepub.com/content/9/3/197.abstract
Rochman, Bonnie. (2012, January 19). Boy or Girl? Why Dads
Want Sons, but Moms Want Daughters. Time. Retrieved on
March
12,
2012
from
http://healthland.time.com/2012/01/19/boy-or-girl-why-dadswant-sons-but-moms-want-daughters/#ixzz1os9zSr5j
Rochman, Bonnie. (2011, August 10). A Blood Test Determines
a Baby’s Sex Earlier than Ever. But at What Cost? Time.
Retrieved
on
March
12,
2012
from
http://healthland.time.com/2011/08/10/controversial-bloodtest-can-determine-babys-sex-earlier-than-ever-but-at-whatcost/#ixzz1os5uRcYZ
Venkatramani, S. H. (1992) Female infanticide: Born to die in
Radford Jill & Russell, Diana E.H. (eds.). Femicide: The
politics of women killing. Great Britain: Open University Press.
Wilson, Jenny. (2011, April 16). Boy bias: India census results
point to selective abortion. Times. Retrieved on March 12,
2012 from http://newsfeed.time.com/2011/04/16/boy-biasindia-census-results-point-to-selectiveabortion/#ixzz1os9QAMeu
Wallis, Claudia & Pelton, Charles. (1984, August 27). Medicine:
Can science pick a child’s sex?. Times Magazine U.S.
Retrieved
on
March
12
from
http://www.time.com/time/magazine/article/0,9171,926848,00.
html#ixzz1os84re7O
Prognostication
- Dr Lalit K Radha Krishna, MbChB Liverpool, MA Medical
Ethics
Consultant in Palliative Medicine, National Cancer Center
Singapore, 11 Hospital Drive, Singapore 169610
Declare the past, diagnose the present, foretell the
future: practice these arts ~Hippocrates~
The process of prognostication amongst the
terminally ill occupies a pivotal role in providing an
estimation of when death is likely (1,2,3). It also
considers the rate of disease progression, the level and
extent of morbidity that the disease and any interventions
may cause and approximates the morbidity and mortality
of drug toxicity that may result from any intervention (3).
Additionally it estimates the cost of both of therapies and
their possible complications as well as those that might
simply arise as a result of the disease itself (3). Yet whilst
it attempts to be prophetic in ascertaining the application
of treatment approaches, and thus has great impact on
the futures of patients and their families, for much of the
time, this process is operator dependent, imprecise,
variable and barely patient centred (1,2).
However despite these uncertainties, it has been
suggested that there exists an expectation of Health Care
Professionals (HCP)s to balance the various
psychosocial, clinical, spiritual, cultural, ethical and
religious relevant to each respective clinical scenario with
their duty to prognosticate. This paper considers if there
is a valid rationale for this posit of a duty to prognosticate
under the ambit of the duty of care and proceeds to
investigate its effects upon the triumvirate of parties
involved; patients, their families and those who must
carry out this duty within the nuanced area of end of life
care in Singapore.
Is there a Duty to Prognosticate?
On the surface there does appear to be a
presumptive duty to prognosticate over issues from
accepted practice guidelines such as those set out by the
standard of good medical practice produced by the
Singapore Medical Council (28). This ideal is said to
emanate from a physician’s duty to provide care,
information and support to the family unit in addition to a
duty to determine the ability of patients and their families,
to prepare themselves for the course of events that are
about to unfold and to face the inevitable. Indeed the
manner family units address the social, financial,
psychological, spiritual and cultural aspects of impending
loss and bereavement is determined by the forewarning
that prognostication provides. Future care planning for
instance is particularly pertinent within the specific
financial and healthcare provisions in Singapore’s health
care system.
This duty to prognosticate also appears to nestle
within the physician’s obligation to protect the rights and
individuality of the patient and their family. Such an
approach thus necessitates the introduction and
balancing of various social, cultural, religious and local
mores along with the impact of the influences of
familialism and familial determination upon this
deliberation and serves to elevate considerations to a
wider plane of cogitation. I will defer discussion of these
matters to a later juncture but will stress the position of
this paper to consider the effects of prognostication
beyond the simple deliverance of estimation of life
expectancy to a holistic contemplation of care provision.
In the meantime, the determination of informed
consent, future care planning, determination of futility and
the resulting decisions upon treatments that will be
offered need to be weighed up too against psychosocial,
cultural, religious, financial and local beliefs, if patient
centred care is to remain more than merely an illusion
(9). Thus physicians are required as part of their duty of
care to balance their own fears and reticence with the
need to fulfil their obligation to play an active role in a
patient’s care. The veil of therapeutic privilege can no
longer be relied upon as patients, their families as well
other HCPs involved in the patients care are in effect left
ignorant, misinformed and unable to make valid decisions
about a wide array of issues.
For the reasons discussed the answer to the
question of whether there is a duty to prognosticate, must
certainly be affirmative and resoundingly so within the
sphere of end of life care, where this obligation appears
further reinforced by the working guidelines and
definitions of palliative and patient centred care. Thus the
pertinent question ought not to be if there is a duty to
prognosticate but how this duty is balanced against
competing obligations that arise within a holistic appraisal
of the 3 parties involved. The duties and expectations
expected by and of the patient, their family and carers
and the HCPs involved in the patient and family’s care
can sometimes be in conflict particularly given the
complex psychosocial, cultural, religious, financial, ethical
and local beliefs and values that imbue each individual
perspective and obligation. This paper will therefore
151
consider some of these issues from a Singaporean
healthcare context.
The effect of prognostication upon the family unit
The implications of a determination of prognosis has
significant impact upon the patient, not simply upon the
approach and avenues of treatments that stand before
them but also in terms of how they will confront the
immense psychosocial, spiritual, financial and care
issues that such a determination would entail. Indeed
while social, spiritual, financial and legal preparations are
mooted from a patient centric stance, these issues ought
to involve the family particularly within a pragmatic
society steeped in familial centric views and one in which
a vast majority of observed patients still chose to either
delegate decision making to the family or chose to work
with the family during any decision making processes.
This complex interlinking and interrelated relationships
and interests between family and patient leads to the
employment of the term ‘family unit’ to encapsulate this
connection between the two parties owing to the
apparent harmony of interests and aligned goals. Such a
precept and indeed the rendering of primacy of concern
upon the family unit within decision making process
rather than solely upon the individual, appears to have
garnered significant support amongst Singaporeans
irrespective of race, creed or religion and appears to be
reinforced by prevailing sociocultural practices (5,44-57).
Such a stance is not surprising given that local
families play a number of roles in the care of patients.
These include the role of a surrogate in any decisionmaking process, an executor of post-mortem wishes, a
psychologist, the main provider of physical care, a
minister to spiritual needs and a provider in financial
matters (67-91). Additionally prevailing psychosocial,
cultural and local practices place specific obligations
upon families on how they carry out their duties, which in
turn reflect upon the social standing of the family. This
refers to the issue of ‘face’ or personal honour, which is
especially amongst Singaporeans. This family unit’s
‘face’ that is determined by the wider family and
community is dependent upon how well they carry out
their social obligations and in particular how well the
patient is cared for (marc).
Protecting the patient from distress, maintaining
their hope and ensuring that they are continuously being
supported throughout their illness and after is key to
maintaining ‘face’. Such an appraisal of duty appears to
underlie the frequent observation that decisions
pertaining to care stances remain the express domain of
families rather than patients themselves. It is also not
uncommon for the patient not to be in receipt of the full
facts of his or her condition as a result of familial
collusion within the local setting. Fundamental to such a
concept is the local credo that a harmonious and calm
lifestyle, free of distress and consternations enhances life
expectancy, which in turn inspires families to go to great
lengths to ‘protect’ patients (marc). Such conduct then
affirms the practice of collusion and nondisclosure that
sometimes adjudges the act of misleading the patient, to
be acceptable (11) (1,2,32,35-38,16-22,24-26,35-37, BIP
NE). Thus poor prognosis are frequently tampered,
intentionally miscommunicated or simply not provided at
all.
152
The effect of prognostication upon Health Care
Professionals
It might on first light seem odd that there ought to be
consideration of this final member of this triumvirate
given that it is clear that the duty to prognosticate nestles
within their professional duty and is in fact an integral part
of their work practice. To be clear prognostication is an
inherent element of clinical practice be it from deciding
upon the best means of providing dressing for a weeping
wound to estimating the various care formulations and
provisions that would be expected for a patient with
chronic progressive diseases such as Rhematoid
Disease, however the place prognostication plays in end
of life decision making sets it apart from these more
‘routine’ of estimations particularly within the local setting.
For one this process of prognostication at the end of
life in the face of multiple comorbidities and confounding
factors is frequently inaccurate and fraught with many
evidential and operator related uncertainties. The lack of
accuracy and reproducibility of prognostic indices and
tools merely heighten such reservations in participating in
this process. Thus for evidence based practice instructed
and inspired physicians, the process of prognostication
appears detached from mainstream medical practice that
relies upon accountability, reproducibility, efficacy and
accuracy. At best prognostication at the end of life
represents an act of ‘guess-timation’ or ‘best guess’ of
clinical outcome (3,4,18,19). Concurrently this situation is
further clouded by the finding that physicians are poorly
equipped and poorly trained for this undertaking despite
its fundamental nature within basic medical care
(Christakis). Unsupported and poorly versed in the
etiquette, communication skills and rudiments of
counselling techniques, physicians tend to be vague and
over optimistic in their judgment, particularly when
dealing with patients and families who would see
optimism as a sign of hope (1,2,3,4,17,25). It is thus
unsurprising that many physicians opt to collude with
families with regards to issues of diagnosis, treatment
options and outlook
Collusion to maintain hope too appears to be
mutually beneficial for both parties especially given the
inherent societal prescription to not to be seen to be
‘giving up’ on the patient irrespective of their outlook and
a corresponding expectation to be seen to be constantly
striving to provide alternatives in the face of
insurmountable odds (tan,Toh). Indeed there is an almost
compulsive need, partly as a result of these prevailing
social and cultural norms within Singapore, to provide
some disease altering treatments at apparently any stage
of the illness in order to propagate this ideal of nonabandonment (11). Incidentally it would seem some hold
that such a posture also dissipates the need to
prognosticate altogether, further highlighting the depth of
inherent resistance to prognosticate amongst HCPs (11).
Indeed it is said, “physicians are socialized to avoid
prognostication”, particularly given that within this
situation, prognostication pertains to death and the
insinuation of failure to forestall the inevitable and meet
professional duties (1,2).
Yet an over optimistic attitude may highlight the
rarely considered emotional aspects of this estimation
both upon the family unit and its effect on the ensuing
care of the patient and the family. Increasingly some
physicians see such action as being a part of their
beneficent duties to the family unit as well as a means of
acknowledging the cultural and societal mores and
expectations stated earlier. Some physicians report that
the motivation behind their actions is fed by a fear of
actualizing a ‘negative self fulfilling prophesy’. This
‘negative self fulfilling prophesy’ forewarns of a spiral of
deterioration in the patient’s condition that is precipitated
by the physician’s estimation and spurred on in part by
the patient’s feelings of despair, abandonment and loss
of hope as a result (10,18,1940,41). It is believed that
this turn of events subsequently leads to the patient
‘giving up’, accelerating a downward spiral of further
worsening of their condition and affirming the connate
cultural, social and local beliefs (10,18,1940,41). Many
local physicians feel that by predicting such outcomes,
they are complicit to a patient’s early demise and
culpable to failing in their duties to the family unit. Some
physicians would thus apportion this resistance to be
accurate and indeed negative in their estimations, to their
duty to be beneficent and non-maleficent. They argue
that by remaining positive and maintaining hope, the
cycle of the “negative self fulfilling prophesy’ will not arise
(11,16,34-37,Tan).
Other physicians attempt to circumvent this problem
altogether by employing clinical inertia. Rather than alter
treatment approaches despite less than favourable
results and change the goals of care in the face of
corresponding poor outcome estimations, some
physicians choose to ‘hold their course’, persist in their
treatment posture albeit using alternative treatment
modalities and combinations which maybe of variable
efficacy that may hold nothing more than a minimal
chance of response and at best a placebo effect (3,4).
However justification for such actions may simply lie in
expounding the idea of hope with the alternative
amounting to abandonment and giving up to some.
Concurrently it would appear that there exists an
inverse relationship between clinical interventions and
prognostication, where the need to prognosticate fades in
the presence of surviving clinical options. This creates
the illusion that the very availability of treatment options
becomes the surrogate for prognosis and reinforces the
clinical inertia approach (9). In the meantime, the
availability of clinical options it would seem, determines
the manner that care is instituted will be steadfastly
adhered to. The presence of alternatives apparently
negates all other considerations and the burdens of the
treatment simply disperse, lost on the cogitations that,
whilst other treatment options exist, death may be
postponed or at least in some cases discussions about
this fact, deferred. The alternative would appear to justify
the means given that it would simply signal an
acceptance of the inevitable which runs in the face of the
prevailing medical ethics and social expectations of cure
at all costs.
To some these uncertainties and concerns merit
setting aside of the recognized short falls and
complications of prognostication. Veritably the process of
prognostication seems to have waned in importance in
the eyes of many clinicians (9). However in reality, the
presence of second, third and even fourth line treatment
alternatives rarely return patients to a state of health that
they were prior to the deterioration, much less to a state
of health that they enjoyed prior to the illness (29).
Prolongation of life at the cost of increased health
burdens, impairment to Quality of Life (QoL) and side
effects may to some be too much to bear. Merely the
presence of other options thus becomes poor surrogates
of prognosis or at best not one that would be universally
accepted.
However there are some who would view the
presence of such alternatives as a means of realizing
their own interests (9,17). In an era of medical tourism,
insurance funded medical care and private medical
services, some physicians find themselves with a vested
interest to continue to proffer sometimes not fully
evidenced, sometimes not clearly effective treatment
options. These vested interests may cloud judgment and
bias treatment approaches and propagate clinical inertia
if only for self-serving pursuits. However before
proceeding down this road, balance needs to be brought
to bear, private medical centres do also possess
treatment options and clinical experience not easily
available to clinicians in the public sector let alone to
others in the country. The presence of such specialized
and personalized care and interventions underpins the
growing market in medical tourism for which nations such
as Singapore continue to benefit from. Thus the venture
of continued treatments along a particular treatment
strategy that others might deem hopeless would appear
warranting of consideration upon their own merits.
Persistence in a treatment stance may also stem
from a fear of a breakdown in the therapeutic relationship
and a disruption of the aura of clinical competence and
effectiveness enjoyed by many physicians. Many
physicians are desirous of this for a number of reasons.
Some as a means of maintaining their status and with
that control as it were upon proceedings. Others, fed by
their general inability, lack of confidence and training
hope to circumvent the need to delve into areas of care
they are ill at ease to confront as a result of such a
disclosure and consequent changes in treatment
approaches (17). For some physicians, the effects of
such augurs upon themselves, is reason enough to
maintain status quo. Indeed the emotional and physical
costs upon physicians are rarely considered. The
emotional ‘disconnect’ often relied upon by physicians is
hardly impenetrable and great personal resolve and
strength is required to maintain this veneer (28). The toll
is hardly inconsequential with studies showing a burn out
rate with associated psychological morbidity of 19-47%
amongst physicians (28,42-50 burnout).
However the ill effects of such resistance to
forewarning patients and their families of the waning
chances of cure and indeed of prolonging survival are
clear. Wills are not written, affairs not put to rest and last
words not said, sometimes under the guise of
maintaining hope.
The effect upon decision makers
The division between the members of triumvirate are
not fixed but can be rather fluid. A pivotal example relates
to the determination of futility and impending demise.
Here there is frequently an understanding between
patient’s families and their HCPs to collude upon poor
outlooks. Whilst the belief in maintaining an element of
hope when prognosticating even in this stage of a
disease process does have some cultural bearing in the
Singapore context and represents the premier reason for
such an alliance, this position does open itself up to
153
withering criticism of paternalism (1,2,10). Here
paternalism is not solely medical but familial too. The
argument follows that through such premeditated
prognostication as deemed by the decision makers, goals
of care become ‘way laid’ and patients are reduced to
mere passengers. Patients have little option but to rely
upon their physicians and family given the little if any
alternative sources of information available to them (25).
Furthermore many patients at this stage of life may be
incapable of making significant decisions and rely upon
the advice and help of the physicians and family (25).
CASE: Consider the case of Rafidah, a senior
lecturer in legal studies who is of Chinese parentage but
adopted by a Muslim family. She was 42 years old when
she was diagnosed with lung cancer. This came as quite
a shock to her husband Najib and their three girls aged
13, 7 and 3 respectively, given that she had never
smoked and lived a ‘healthy lifestyle’ yet such a
diagnosis is not altogether uncommon amongst ladies of
Chinese extraction. Despite multiple lines of treatment,
Rafidah’s condition continued to progress. It was at this
point that her private oncologist suggested that she
continue with an experimental drug in an attempt to
control the disease. Whilst Rafidah was clear that she did
not favour this option and would chose instead to pursue
comfort measures, her husband seeing this as a ray of
hope chose to pursue this treatment option. Interestingly,
Najib did so despite advice to the contrary from second
and third opinions from other oncologists.
Here it was later suggested that the impetus for
offering a fourth line treatment may have been as a result
of self-serving financial interests as well as a need to
maintain the status of the physician as a renowned
healer and a purveyor of hope. In the meantime Najib’s
rationale might have been to seek solace in the
knowledge that all avenues were being explored as every
effort was being sought to prolong his wife’s life and that
he was meeting his societal expectation of nonabandonment and the maintenance of hope. Neither of
these rationales appeared to have considered the
patient’s opinion much less what she considered to be in
her best interests. Autonomy, it could be argued is
subverted given that the apparent options open to the
patient are those prearranged by her husband and their
physician and cultural demands would have seen
Rafidah acquiesce to her husband’s request. Here the
asymmetry of power that exists between patient and
physician is also perpetuated.
It is thus unsurprising that the prognostication of
futility falls prey to concerns of paternalistic tendencies
especially given that for the most part, it is the physician
and the family that are the architects of the fate of the
patient. The illusion of choice appears to be maintained
by steering patients to a small section of treatments that
the decision makers themselves formulate and deem
acceptable, as was the case in Rafidah’s context.
Physicians abetted by the family preside over
decisions to cease and desist any provision life altering
treatments. This would include options that range from
the invasive, such as ventilator support, to those that are
significantly less so, such as blood transfusions and
antibiotic treatments. Importantly within this remit
cessation of life support and the viability of terminal
sedation also become possible, once again upon the
154
determination of the decision makers. However it is
argued that physicians by virtue of their training,
knowledge and experience are still best placed to decide
on viable options and steer patients onto only viable
treatment options whilst the family decision makers are
best placed to venture options that are clearly viable.
CASE: Consider the case of Deborah, who was a 56
year old lady with endometrial cancer who exhausted all
her treatment options in the face of a rapidly progressive
disease process. Whilst there was the option of ‘stem cell
treatment’ that was being offered in China, the family
were clearly not financially able to meet this request so
the option was never mooted.
Meanwhile the determination of futility runs parallel
and feeds into the ‘negative self fulfilling prophecy’, given
that upon a verdict of futility; options to investigate and
correct any reversible causes for deterioration are
ceased. Such a decision would also negate any option
for the escalation of treatments such as intravenous
antibiotics. This then prevents any opportunity of
stemming the deterioration and inevitable demise of the
patient. Thus the determination of futility could be then
viewed as ushering the fulfilment of the ‘negative selffulfilling prophecy’ (1,2,10). The end result troubles many
physicians despite support from the family decision
makers, feeling that their act of determination has a
significant part to play in the demise of the patient,
leading many to opt for the softer more positive stance.
It is also here in considering the issue of futility that
an example of the need to include appropriate
consideration of a patient’s circumstances arises. It is
well known that there is a variance between what is
readily available in Singapore may not be so easily
accessible in other nations. Likewise, treatment options
in one part of a developing nation, say a city, may not be
the same as that in the rural areas. Awareness of the
family unit’s financial and social circumstances as well as
their ability to secure treatment at other sites is
imperative. A recent example was a 24-year-old patient
who developed multi-organ failure from a newly
diagnosed hematological malignancy. Physicians in his
country pronounced his condition terminal and further
interventions futile and prescribed comfort measures
only. However, the family unit was not without means and
secured transfer to a Singaporean unit where he was
treated with good effect. Thus prognostication ought to
consider such matters both in foreseeing as well as
foretelling a determination. Indeed like most other clinical
considerations, prognostication is a context dependent
activity.
A possible solution
The proposal offered here is by no means meant to
be a solution to what ails the duty of prognostication but
merely proposes a means of confronting some of these
issues. This is especially so given that some require a
generalised approach whilst others require a particular
and personalised approach.
Many of the issues that have been highlighted
provoke the need to reconceptualise the process of
prognostication and reformulate attendant attitudes
towards this facet of the duty of care whilst balancing
considerations with competing obligations. Clearly the
balancing of factors cannot simply be the express remit
of physicians any more than they are the families.
Instead prognostication ought be a wider more inclusive
process where proclivities and motivations can be
tempered. The employment of existing prognostication
indices along with second opinions and the aid of MDTs,
will undoubtedly improve prognostication as would
redressing the undoubted shortfalls in training,
communication skills and the attendant deficits in clinical
experience to prognosticate effectively, there arises the
need to consider the first step of prognostication as one
that is focused upon improving the ability of physicians to
determine the disease course and effectively convey their
findings. The second step of this progressive process is
the effective elucidation of prognosis through the
combination of available techniques whilst the third step
involves gaining a holistic appreciation of the family unit’s
social, psychological, cultural, financial and religious
circumstances in order to garner as accurate an
estimation as possible and determine the impact
imparting this information will have on the family unit.
Once more these facets maybe helped by the presence
of an MDT.
The fourth step involves the use of appropriate
means, training and personal skills to impart this
information to the family unit as a whole. The fifth step is
the provision of effective support for the family unit, be it
from a psychological, social, financial or religious
perspective. This would also entail confronting any
collusion that may occur and treating this appropriately
and with sensitivity. Education of both family and staff
upon this matter is already on the way in Singapore,
albeit at an early stage.
Conclusion
The duty to prognosticate remains defined and sits
within the remit of the duty of care. However there are a
number of reasons for the problems that are attached to
the failure of physicians to appropriately determine
prognosis, some sociocultural whilst others hinge on
professional and personal factors. Similarly the effects
upon the family unit too require discernment. This paper
has shown this process to be fluid and case specific
requiring a holistic interpretation of conditions rather than
a simplistic reflection of delivering an estimation. Clearly
there are also times when the duty to prognosticate will
upon the discernment by the MDT led by a holistic
appraisal of the specific contexts of the patient’s
situation, be trumped by other competing duties.
Whilst the antidote to what ails the duty of
prognostication is some time away, present practices of
procrastination, collusion and misleading patients clearly
cannot continue if patient centred care is not to become a
simple catch phrase or an illusion of modern medicine.
Instead this duty needs to confront and balance the
competing duties that arise and be carried out in a
contextually
sensitive,
accurate,
honest
and
individualised manner.
References
1. Christakis NA. Prognostication and Bioethics. Daedalus
1999;128[4]:197-214
2. Christakis NA. Lamont EB. Extent and determinants of error
in doctors’ prognoses in terminally ill patients: prospective
cohort study. BMJ 2000;320:469-73
3. Glare P, Sinclair C, Downing M, Stone P, Maltoni M, Vigano
A. Predicting survival in patients with advanced disease.
European Journal of Cancer 2008;44:1146-56
4. Glare PA, Sinclair CT. Palliative Medicine Review:
Prognostication. J Pal Med 2008;11[1]:84- 103
5. Glare P, Virik K, Jones M, Hudson M, Eychmuller S, Simes
J, Christakis N. A Systematic Review of Physicians’ Survival
Predictions in Terminally Ill Cancer Patients. BMJ 2003;327:
195-8
6. Stevenson J, Abernathy AP, Miller C, Currow DC. Managing
Comorbidities in patients at the end of life. BMJ
2004:329:909-12
7. Wusthoff CJ, Mcmillan A, Ablin AR. Differences in Pediatric
Oncologists’ Estimates of Curability and Treatment
Recommendations for Patients with Advanced Cancer.
Pediatr Blood Cancer 2005;44:174-181
8. Anspach RR. Prognostic Conflict in Life – and – Death
Decisions: The Organization as an Ecology of Knowledge. J
Health of Health and Social Behavior 1987;28:215-31
9. Rich B. Defining and Delineating a Duty to Prognosticate.
Theoretical Medicine 2001;22:177-92
10. Christakis NA, Iwashyna TJ. Attitude and Self-reported
Practice Regarding Prognostication in a National Sample of
Internists. Arch Intern Med 1998;158:2389-95
11. Ho ZJM, Krishna LKR, Yee CPA. Chinese Familial Tradition
and Western Influence: A Case Study in Singapore on
Decision Making at the End of Life. JPSM 2010;40[6]:932-7
12. Saraiya B, Bodnar- Deren S, Leventhal E, Leventhal H. End
of Life Planning and its relevance for patients’ and
Oncologists’ Decisions in Choosing Cancer Therapy. Cancer
2008;113[12 suppl]:3540-7
13. Rogg l, Loge JH, Aasland OG, Graugaard PK. Physicians’
attitude towards disclosure of prognostic information. A
survey among a representative cross section of 1605
Norwegian patients. Patient Education and Counseling
2009;77:242-7
14. Rogg L, Graugaard PK, Loge JH. Physicians’ interpretation
of the prognostic term “terminal”: a survey among Norwegian
Physicians. Palliat Support Care 2006;4[3]:273-8
15. Markowitz AJ, McPhee SJ. Complexities in Prognostication
in Advanced Cancer. “To help them live their lives the way the
want to” JAMA 2003;290:98-104
16. Drought TS, Koenig BA. “Choice” in End of Life Decision
Making: Researching fact or Fiction? The Gerontologist 2002;
42[special Issue iii]:114-28
17. Finlay E, Casarett D. Making Difficult Discussions easier.
Using prognosis to facilitate transitions to hospice. CA Cancer
JK Clin 2009;59:250-63
18. Head B. The Prognostication Problem. Home Healthcare
Nurse 2001;19[9]:535-6
19. The Duty of Care. Singapore Medical Council. Accessed
13/02/2011
http://www.smc.gov.sg/html/MungoBlobs/204/1022/SMC%20
Ethical%20Code%20and%20Ethical%20Guidelines.pdf.
20. General Medical Council. Duties of a Doctor. Accessed
24/4/2012
http://www.gmcuk.org/guidance/good_medical_practice/duties_of_a_doctor.a
sp
21. World Health Organization [WHO] definition of Palliative
Care.
Available
via
WHO
http://www.who.int/cancer/palliative/definition/en/
Accessed
26/06/09
22. Krishna L, Chin J. Palliative Sedation within the Duty of
Palliative Care within the Singaporean Clinical Context. Asian
Bioethics Review 2011;3(3): 201-215
23. Yang MG. Kwee AK. Krishna L. Should patients and family
be involved in "Do not resuscitate" decisions? Views of
oncology and palliative care doctors and nurses. Indian J Pall
Care 2012;18(1): 52-8
24. Foo WT, Zheng Y, Yang GM, Kwee AK, Krishna LKR.
Factors considered in end of life decision making of health
155
care professional. Am J Hos Pall Med online first 2012, july 16
2012
25. Hanvoranavongchai P, Medical Savings Accounts: Lessons
Learned from International Experience. World Health
Organization. EIP/HFS/PHF Discussion Paper No. 52; 2002.
26. Taylor R, Blair S, Financing Health Care: Singapore’s
Innovative Approach. Public Policy for the Private Sector.
World Bank Group. Note No. 261; May 2003.
27. Healthcare Financing. Singapore Health Care System.
Ministry of Health Singapore. Accessed 13/02/2010.
www.moh.gov.sg/mohcorp/careers.aspx?id=5252#hf
28. Lin J. Powering up palliative care- what’s needed. Insight.
SMA
NEWS.
Accessed
24/4/2012
http://news.sma.org.sg/4210/In_Sight.pdf
29. Singapore Hospice Council. Information for Patients.
Accessed
24/04/2012
http://www.singaporehospice.org.sg/11.3_faqsforpatients.htm
30. Tan JOA, Chin JJL. Kaan TSH, Chan TE. What Doctors say
about care of the dying. Lien Foundation 2011. Singapore
31. Lien Center Press Release. Doctors are caught between
ensuring patient autonomy and respecting families’ wish for
nondisclosure and collective decisions. Accessed 17/09/2011
http://www.lienfoundation.org/pdf/news/WDS_Press_Release
_Final.pdf
32. Koh BS. Living with the end in mind. A study of how to
increase quality of death in Singapore. Lien Foundation
accessed
24/04/2012
http://www.lienfoundation.org/pdf/publications/living_with_the
_end_in_mind.pdf
33. Low JA, Ng WC, Yap KB, et al. End-of-life issuespreferences and choices of a group of elderly Chinese
subjects attending a day care centre in Singapore. Ann Acad
Med Singapore. 2000;29(1):50-6.4
34. Toh HC. Providing Hope in Terminal cancer: When is it
appropriate and when is not? Ann Acad Med Singapore
2011;40:50-5
35. Tan TK, Teo FC, Wong K, Lim HL. Cancer: To tell or not to
tell? Singapore Med J. 1993;34(3):202-3.
36. Chan CKL, Yau M Death preparation among the ethnic
Chinese well-elderly in Singapore: an exploratory study.
Omega. 60(3):225-39
37. Low JA, Kiow SL, Main N, et al. Reducing collusion between
family members and clinicians of patients referred to the
palliative care team. Perm J 2009;13:11-5.
38. Ong WY, Yee CM, Lee A. Ethical dilemmas in the care of
cancer patients near the end of life. Singapore Med J
2012;53(1):11-16
39. Low YYS.'Who is Responsible for this Patient?': A Case
Study Analysis of Conflicting Interests between Patient,
Family and Doctor in a Singaporean Context Asian Bioethics
Review – 2011;3(3):261-71
40. Phua J, Kee AC, Tan A et al. End-of-Life Care in the
General Wards of a Singaporean Hospital: An Asian
Perspective. J Palliat Med 2011;14(12):1296-301
41. Ong JK, Back MF, Lu JJ et al. Cultural Attitudes to cancer
management in traditional South East Asian Patients.
Australasian Radiology 2002;46(4):370-4
42. Krishna L. Best Interests Principle in the determination for
Palliative Sedation within the Singapore context. Nursing
Ethics
published
online
30
April
2012
doi:10.1177/0969733011433316
43. Krishna L. Decision making at the end of life: A Singaporean
Perspective. Asian Bioethics Review. 2011;3(2):118-126
44. Krishna L. Nasogastric feeding at the end of life: A virtue
ethics approach. Nurs Ethics, Nurs Ethics 2011; 18: 485-494
45. Goh CR Challenges of cultural diversity. In J Beattie & S
Goodlin (eds.), Supportive Care in Heart Failure Oxford; New
York: Oxford University Press 2008.pp. 451-461.
46. Goh CR. Culture, ethnicity and illness. in Palliative Medicine
TD Walsh, AT Caraceni, R Fainsinger, KM Foley, P Glare, C
Goh, M Lloyd-Williams, JN Olarte & L Radbruch (eds.),
PA:Saunders/Elsevier Philadelphia, 2007 pp. 51-54
156
47. Levine MD. Disconnection: The Clinician’s View. The
Hastings Center report 1976;6[1]:11-12
48. Maltoni M, Caraceni A, Broekaert B, Christakis N,
Eychmuller S, Glare P, Nabal M, Vigano A, Larkin P, De
Conno F, Hanks G, Kaasa S. Prognostic Factors in Advanced
Cancer
Patients:
Evidenced
–
Based
Clinical
Recommendations- A study by the Steering Committees of
the European Association for Palliative Care. J Clin Oncol
2005;23:6240-8
49. Dietzl I, Borasio GD, Schneider G, Jox RJ. Medical Errors
and Patient Safety in Palliative Care: A review of Current
Literature. J Pall Med 2010;13[12]:1469- 74
Cloud Computing and its
ethical issues
- J. Thresa Jeniffer
Department of Computer Science Engineering, St.
Joseph’s College of Engineering, Old Mahabalipuram
Road, Jeppiarnagar, Chemmancherry, Chennai-600119,
Tamil Nadu, India
Abstract
Knowledge and information have always been
responsible for the advancement of humankind. They
have helped to organize societies, build peace and
sometimes were the reason for conflicts. Both of them if
vested in the hands of a few can enslave the whole
society. But if used wisely they can help to liberate
people from their clutches. Popularly, cloud computing is
“stuff’s not on your computer” and it refers to offsite
storage of client data. The applications of cloud
computing are practically limitless. The benefits of cloud
computing
include
reduced
infrastructure
and
management, cost effectiveness, improved work
production, fast and efficient communication, constant
service, ease of use, mobility, immediate access to
updates and enhanced security. Many of the emerging
technologies often create new and unsuspected technical
problems as well as new and unanticipated ethical
challenges. Though the benefits of cloud computing
seem convincing, there are many potential problems
associated with it. The most important are privacy and
security. There are several ethical issues with reference
to cloud computing involving loss of control, unauthorized
access,
data
corruption,
infrastructure
failure,
accountability, ownership, function creep, monopoly and
lock in, privacy and cultural imperialism and these issues
are discussed.
Introduction
Cloud computing is considered to be one of the
fastest growing technologies in the computing industry
and the one which has the capability to affect almost all
aspects of computing. Experts opine that it saves time,
money and offers large amount of storage, applications.
Though cloud computing has become the current
industry’s buzz word, it is still an emerging technology.
Users, cloud service providers and industrial experts are
still unaware of the ethical and legal consequences of
this technology. It is also useless to wait till these risks
and consequences reveal themselves. It is advisable to
study and recognize such ethical issues at the earliest in
order to save time and money to be spent later in dealing
with them.
History
Cloud computing can be defined as virtualization of
resources, maintained and managed by a cloud service
provider. It is nothing but providing hosted services over
the Internet. The history of cloud computing can be dated
back to the 1960s. It was then the concept that would
deliver computing resources to different locations through
a global network was originally introduced. An idea of
‘intergalactic computer network’ which is quite similar to
the present cloud computing technology was proposed
by J.C.R Licklider. Another expert John McCarthy
envisioned that computation may someday be organized
as a public utility like water or electricity (Timmermans et
al., 2010).
The evolution of cloud computing involves many
phrases like grid computing, utility computing and
distributed computing. It is enough for the user to know
the endpoint to access the application. The user does not
care much about what goes on in the cloud. Behind the
service interface, there is a grid of computers to provide
the resources and the grid is usually hosted by a
company. Thus grid computing plays a role in cloud
computing. Users pay only for the amount of resources
utilized by them and this pay-for-what-you-use is similar
to utility computing. The resources used in an application
or the resources used to provide a service are generally
widely distributed thus making distributed computing to
play its role in cloud computing.
Users can gain access to their files and data from a
web browser, via the Internet. It is not necessary to
download and install expensive software for using an
application (Mohammed, 2009). Users can easily access
the application through the cloud as it is already installed
online remotely and cloud offers many applications free
of charge. We use many applications from the cloud
without realizing that they are from the cloud. Gmail,
Hotmail, Yahoo, Google, Twitter are all examples of
cloud computing applications. To use them we need not
have an email management server. The cloud service
providers take care of the software and hardware needed
to make use of these applications. The services provided
by cloud computing are generally of three types. They
are infrastructure, platform and software:
Infrastructure as a Service (IaaS)
It mainly provides infrastructure like virtual servers. Users
are given the privilege to start, stop and access them as
they wish and these virtual servers are used for storage
purposes also. Amazon web service is the best example
for this type.
Platform as a Service (PaaS)
Platform as a Service provides software and product
development tools using which developers can create
applications on the provider’s platform over the internet.
Software as a Service (SaaS)
This service provides software and products. If the user
knows the endpoint to access the services, the Software
as a service can be used from anywhere.
The cloud may be a private cloud or public cloud.
The public cloud covers a vast area or a large number of
users and it can distribute service to any user on the
internet. Amazon is the largest public cloud provider. A
private cloud, like a data center provides service to a
limited number of users. Sometimes public cloud
resources are used to create private cloud (Rouse,
2010).
Nature of the technology
The main trait of cloud computing is virtualization of
resources and storage. All the information and tools are
stored or preserved in the resource cloud by the cloud
service provider and are delivered to the user on
demand. The resources are also added or removed
based on the changes in needs. These resources are
used with maximum efficiency and they serve multiple
needs of several users simultaneously. People or
organizations are ignorant about where the data is stored
and they assume that all the data and services are
available in the internet (Hartig, 2009). This emphasizes
the nature of ease of use of cloud computing. The
resources and information are shared, delivered to the
users and are controlled by the cloud providers in a quick
and efficient manner. This makes accessibility to
information as simple as possible.
Advantages
Buying, downloading or installing an expensive
software is no more necessary as software are used
directly from the cloud through internet access and a
huge range of applications are provided by the cloud of
which some are free of charge. Storage costs are
reduced for the users as cloud provides large amount of
space for storage. Users can store their files and
information in the cloud and retrieve them from any
remote place whenever needed by getting connected to
the internet. They can make use of other resources
available in the cloud also in the same way. Payment can
be made only for the amount of resources utilized and
this makes cloud computing cheaper. This technology is
also less labour intensive as businesses do not have to
appoint special IT staff for maintaining or updating the
software and for fixing the bugs. The cloud service
provider maintains and manages the cloud (Arno, 2011).
Cloud computing promotes Green computing.
Microsoft claims that cloud computing reduces a
business’ carbon emissions by 30%, as it is not needed
to power an entire server and payment is made only for
what is used online. Thus in this way cloud computing
promotes a greener environment.
Risks of Cloud Computing
Privacy
As users do not physically possess storage of their
data, their personal information, files and data are stored
in the cloud which is in turn managed by the cloud
service provider. In this circumstance, risk of
inappropriate access of data arises and data can be
mishandled by anybody who gains access to it. Hence
users have to demand assurance of privacy and security
from the cloud providers (Arno, 2011).
Dependency
Since most of the information and files of the user
are managed by the cloud provider, the user becomes
more dependent on the cloud providing party. Risks like
the cloud provider going out of service may occur. It
becomes hard for the user to retrieve back all the data
from the cloud provider. Then such data has to be
157
migrated to another cloud which is equally tiresome and
technically difficult.
Cost problems
Cloud offers are highly expensive initially and data
centers have to buy or develop the software that runs the
cloud. Not only that, the customers who arrive are
charged a higher price and they face a lot more issues
than who come late.
Knowledge and Integration
Much knowledge is needed for implementing cloud
technology and to address the issues that arise out of
this technology. So businesses must take steps to
promote the cloud computing knowledge of their staff
before they implement the technology. Integration of
processes, resources and technologies is also required
before implementing this technology and it seems to be a
complex process.
Ethical issues
Security and privacy
The topmost concern in using cloud computing
resources is security of confidential information. There is
a risk that employees of cloud vendors may access
confidential information and use it to the detriment of a
client. Because of the nature of cloud computing
services, there is a risk that client information will be
subject to destruction or disclosure by unauthorized
access.
Privacy is another major issue which businesses cite
as a matter of concern when it comes to cloud
computing. The cloud service providers collect
voluminous amount of data about users and their
businesses, and much of it is stored in data centers
around the world. Any sensitive information could be
leaked out or even destroyed by any disgruntled
employee of the cloud provider or any competitor.
Unauthorized access of client information is the biggest
threat posed by cloud computing. All the advantages and
merits of this technology go waste if proper privacy and
security are not assured by the cloud provider
(Timmermans et al., 2010).
Loss of direct control
In businesses which implement cloud computing,
any information that is to be stored locally is stored in the
cloud. The user thus places his data on machines he
cannot have control. This shifts the control of data from
users to third parties who provide the cloud. This loss of
control over data can in turn lead to many problems.
There is a risk that any employee of cloud provider or any
competitor can gain unauthorized access to data. Since
data is not directly controlled by the user, data may
sometimes be corrupted. The infrastructure provided by
the cloud vendor is prone to failure. When some failure
occurs, it may be difficult to trace out the cause of the
failure or who is responsible for the failure. There is very
little chance of availability of solid evidence to find the
responsible person when a failure occurs (Grimes, 2009).
Involvement of many people
Data is stored in multiple physical locations, across
many servers around the world, possibly owned and
managed by many different organizations. So many
people have share in any action that takes place within a
cloud. Moreover, responsibilities are divided between
customer and provider of the service. So neither of them
could be held responsible for problems that arise in the
158
cloud and neither of them is in a good position to address
the problem also. This is ethically known as ‘problem of
many hands’. This occurs as a result of the complex
structure of the cloud services and it is difficult to
determine who is responsible, in case something
undesirable happens (Haeberlen, 2010).
Self-determination and Accountability
Information self-determination is the right or ability of
individuals to exercise personal control over the
collection, use and disclosure of their personal data by
others. The cloud providers must be open and
accountable with reference to their data management
practices. They should seek informed consent from
individuals (Cavoukian, 2008).
Accountability empowers users to ensure that
personal data, stored in the cloud is managed properly.
Users are allowed to check whether the cloud providers
are performing as they agreed. It guarantees
accountability –transparency, but this creates a light
tension between privacy and accountability (Haeberlen,
2010).
Ignorance of Ownership
The users are generally ignorant about what data
are stored in the cloud, how the data is stored, who has
access to the data and what the cloud providers can do
with the information. Thus the user may lose his freedom
of ownership over the data. This induces dependency
problems as the user becomes solely dependent on the
cloud provider. Moreover, the information is located in
multiple physical locations in the cloud, thus making it
impossible for the user to determine how this data is
accessed. Identification of fraud and theft is also much
difficult. It is also agreed that information stored with a
third party like cloud computing provider has weaker
privacy protection than when the information remains
only in the possession of the user (Murley, 2009; Grimes,
2009).
Deperimeterisation
Deperimeterisation involves the disappearing of
boundaries between systems and organizations, which
are becoming connected and fragmented at the same
time. It blurs the border between what lies within one’s
own IT infrastructure and what lies outside of it. Not only
this, but also the border of the organization’s
accountability becomes vague and this can lead to a
confusion and misunderstanding between the user and
cloud service provider (Pieters, 2009).
Function creep
It involves a serious danger in which a data
collected for a specific purpose is used for some other
purpose without the knowledge of the owner. It is in fact a
threat to the privacy of the owner. For example, a
database with biometric data of citizens may be designed
to be used for authentication purposes. But it is not fair to
use it for crime investigations (Pieters, 2009). This
function creep occurs because of user’s loss of control on
the data. As time passes, users become unaware of what
data is being used for what purpose. This could lead to
unanticipated consequences.
Monopoly
It is the tendency of power being invested in the
hands of only a handful of companies (Nelson, 2009).
Only those companies, in the future will acquire a
domineering position in the market of cloud computing
services. This might be harmful to the users since they
might be robbed off their autonomy to make use of their
data in the cloud. The usage of their own resources may
be dictated by powerful cloud corporations.
Lock-in
The height of dependency problem leads to lock-in.
It is a situation in which users are too much dependent
on the cloud provider that they are unable to move or
migrate their data from one provider to another provider
or back to their in-house IT environment. The users are
more or less locked-in by the cloud provider and they
have to be at the mercy of the cloud provider
(Timmermans et al., 2010).
Service Failure
Sometimes the cloud user may not be able to use
the services efficiently due to certain reasons. There is
always the risk of losing Internet connectivity and the
works within a company may be considerably disrupted
due to Internet downtime. Reduced Internet speed may
pose a danger in the industry.
Measures to address certain ethical issues of cloud
computing
Many unwanted issues of cloud computing have not
yet been identified. But it is now essential to deal with
those issues which are foreseeable and this may prevent
undesirable consequences (Pieters, 2009). According to
TLIE (2011), some of the precautionary principles
include:
Confidentiality
Users can assure that the cloud vendors agree to
keep all personal and sensitive information private. A
sufficient assurance might be provided if the vendor
publishes a privacy policy, and contractual provisions are
always needed to assure confidentiality.
Physical Security
Security monitoring has to be provided round the
clock by the cloud providers and physical access to
computers can be limited to only authorized persons in
charge of servers.
Network Security
Cloud vendors can have firewalls blocking
unauthorized connections and this has to be audited by
third parties periodically.
Software Security
The cloud providers need to conduct independent
audits of software security periodically and software
updates have also to be carried out within thirty days of
publication.
Data Security
Some additional data security measures proposed
by Newton involve encryption, server security, client
security and password security.
Encryption
All transmission of sensitive data such as passwords
and client information must use the Secure Socket Layer
(SSL). SSL is generally the standard encryption
technology and it can completely secure communications
over public and also untrusted networks. If the URL for
secure information begins with https, then it can be
confirmed that SSL is being used.
Server Security
In addition to SSL, a third party audit can be
conducted on the cloud provider’s services since it is
difficult to determine or assess their security by the client
himself. Such third party audit services are provided by
companies like McAfee.
Client Security
Data which is stored in the client’s laptop or desktop
can be secured with a firewall or antivirus protection. For
windows users, Google Pack offers free antivirus and
antispyware.
Password Security
The password chosen has to be secure and strong
as weak passwords would undo all the efforts of SSL,
Server and client security. For this purpose, free
password generators and managers could be used like
the “password Safe”.
Performance Efficiency
The amount of downtime, permissible or acceptable
should be negotiated clearly. It can be guaranteed by
service level agreements, which provide a minimum level
of uptime, with penalties for failure to meet the agreed
level.
Data Availability
Data should be readily available whenever clients
need them. The possible ways to attain an efficient level
of data availability include storing them in multiple
physical locations and taking periodical back-ups of data.
Geographic Redundancy
If data is stored just in one center, then a failure at
that point would lead to the unavailability of data. Hence
data must be made available in multiple data centers.
Multiple Internet service providers and power grids
should be available in a network of data locations.
SAAS provider back-ups
Data centers can have multiple back-ups during the
day. At least one back-up location should be a
considerable distance away from the data center. Backups can be taken multiple times per day and stored in
multiple secure offsite locations.
User Back-ups
To avoid risks, regular back-ups of data from SAAS
provider can be taken and stored. For this purpose, the
SAAS provider must allow a full export of data from their
system.
Data portability
Cloud providers have to ensure users that they will
be able to use and download all data in a commonly
used format and this will make data migration simpler to
an extent.
Conclusion
As an emerging technology, cloud computing
involves virtualization of resources and has certain
advantages like access to expensive software and a
huge range of applications. But at the same time it has
some ethical issues pertaining to security and privacy.
Hence it is necessary to solve these issues so that the
fruits of this technology will be of use without any
untoward consequences.
Acknowledgments
The author thanks the authorities of St.Joseph’s
College of Engineering for encouragements.
References
Arno, C. (2011). The Advantages of Using Cloud Computing.
Cloud computing Journal.
159
Cavoukian, A. (2008). Privacy in the Clouds. In: Identity in
Information Society. pp. 89-108.
Grimes, J.M, Jaeger, P.T and Lin, J. (2009) Weathering the
Storm: The Policy Implications of Cloud Computing.
Haeberlen, A. (2010). A case for the accountable cloud.
SIGOPS Oper. Syst. Rev. 44, 2, 52-57.
Hartig, K. (2009). What is Cloud Computing? Cloud computing
on Utilizer.
Mohamed, A. (2009).
A History of Cloud Computing.
http://www.computerweekly.com/Articles/2009/03/27/235429/
a-history-of-cloud-computing.htm
Murley, D. (2009). Law Libraries in the Cloud. Law Library
Journal,
Vol.
101,
No.
2.
SSRN:
http://ssrn.com/abstract=1335322
Nelson, M.R. (2009) The Cloud, the Crowd, and Public Policy.
Issues
in
Science
and
Technology.
http://www.issues.org/25.4/nelson.html.
Newton, J. The Ethics and Security of Cloud Computing.
www.iltanet.org.
ILTA
white
papers.
Infrastructure
Technologies.
Pieters, W. and
Cleeff, A.V. (2009). The Precautionary
Principle in a World of Digital Dependencies.
Rouse, M. (2010). Cloud Computing. TechTarget.
Timmermans, J., Ikonen,V., Stahl,B.C and Bozdag,E. (2010).
The Ethics of Cloud Computing: A Conceptual Review.
TLIE (2011). Malpractice and Ethical risks in Cloud Computing.
Texas Lawyers’ Insurance Exchange. No. 2.
Indian Marine Turtles in Soup
- A.J. Thatheyus, Ph.D.
PG & Research Department of Zoology, The American
College, Madurai-625 002, Tamil Nadu, India
Introduction
Turtles evolved about two million years ago, and
have remained as an archaic group virtually unchanged
in their basic characters. They are highly diverse within
the group exhibiting world wide distribution and all the six
zoogeographical realms have their representatives.
Turtles belong to the order Chelonia which includes
thirteen families comprising the marine turtles, the pond
turtles, the tortoises and the soft shell turtles. They are
poikilothermous and occur with great diversity in the
equator. Indian turtle fauna is formed of about 31 species
and subspecies belonging to five families and is found in
the deserts of Rajasthan, the tropical rain forests of
Kerala, the hill streams of Assam, the estuary of the river
Ganges and the seas surrounding the Andaman and
Nicobar islands(Das, 1985).
India provides the habitat for a remarkably diverse
and important assemblage of turtles. Acting as an
integral part of Indian ecology, they inhabit the rivers,
canals, tanks and surrounding oceans; still others more
terrestrially inclined occupy plains, mountains, forests
and even deserts. Turtles play a major role in maintaining
a natural balance. The herbivorous forms keep an
effective check over the growth of aquatic weeds thus
helping to maintain open–water. Some of them act as
scavengers by rendering dead bodies. By eating injured
or diseased fish, they help in maintaining healthy fish
populations.
160
Marine turtles
Turtles are classified based on the method by which
the head is withdrawn into the shell. They are classified
in to vertical necked and side necked turtles. The marine
turtles are vertical necked and their heads are almost non
retractable. They are powerful swimmers and frequently
undertake long nesting migration.
Marine turtles popularly called as fossil turtles are
air-breathing reptiles living in the oceans for over 200
million years. The seven species of marine turtles include
flat back, green sea turtle, Hawksbill, Kemp’s Ridley,
Leatherback, Loggerhead and Olive ridley. Marine turtles
are found in all oceans except the Arctic Ocean. India
has major nesting sites for five endangered species of
marine turtles. According to the IUCN Red List of
Threatened Species, Eretmochelys imbricata (Hawksbill)
and Dermochelys coriacea (Leatherback) are critically
endangered and Chelonia mydas (Green turtle) and
Caretta caretta (Loggerhead) are endangered while
Lepidochelys olivacea (Olive Ridley) is vulnerable. In
India, marine turtles are severely affected by incidental
catch in capture fisheries, coastal development,
depredation of eggs and habitat loss.
Indian turtles
Little is known about the taxonomy, behaviour,
distribution and nesting of Indian turtles. Compared to
other reptiles, the turtles are virtually defenseless and
have an array of enemies which congregate at nesting
sites to eat the eggs and hatchlings. Turtles lay their
eggs and leave them to the mercy of nature. The
predators mainly include crabs, ants, beetles, barnacles,
lizards, boas, sharks, rats, mongooses, foxes, jackals,
pigs and birds. Turtle populations of India are dwindling
at a faster rate and the main reason that can be
attributed is the demand for turtle meat in Bengal. But if
this turtle trade is not properly managed, as in Bengal,
the turtle resources of other regions would vanish beyond
their capacity to regenerate.
Turtle flesh and eggs are used as medicine and
aphrodisiac. Turtles are consumed as a source of protein
or as a luxury food. The neck and tail bones and the
viscera are used in soup. The fat is used for soaps and
creams while the neck skins are used in leather articles.
The skull is used in jewelery and ornaments and the
animals are sold as stuffed specimens to tourists. Turtles
of India exhibit a decline as they are heavily exploited for
their flesh, shell, skin and eggs. In India turtle flesh is
used to treat tuberculosis, indigestion and weakness of
body and mind. Turtles also suffer due to the effects of
pollution, deforestation, incidental capture and alteration
or destruction of habitat brought about by wrong land use
patterns.
Opening of new shacks (temporary shops) and
lighting along the beaches along with other excessive
tourist activities may be a reason for the decline in the
number of nests. The declining trends of nesting may
also be due to the unfavourable weather, the directions
and velocity of the wind and water currents. Plundering of
marine turtle eggs is a serious threat. Eggs can be easily
consumed than the flesh with much acceptance. Turtle
meat is cheap as they can be easily caught and stored.
They can be kept alive and immobile for weeks by turning
on to their backs. They are transported and killed by
inhumane methods. Crammed into small baskets, with
their flippers stitched or wired together, turtles are sent to
the market. The sellers used to cut the live turtles in front
of the customers and slice off the animal when the heart
continues to beat.
Olive Ridley Turtles
Olive Ridleys are distributed in Africa, America, Asia
and Australia and in India they are found in Andaman
and Nicobar Islands, Andhra Pradesh, Goa, Gujarat,
Kerala, Lakshadweep, Maharashtra, Orissa and west
Bengal. Olive Ridley is an annual nester laying about 80180 eggs. They normally feed on molluscs, crustaceans,
fishes and jellyfishes. They are capable of foraging in
deep waters. The Olive Ridley turtles nest together in
numbers reaching up to several thousands. This
spectacular congregation event is called as ‘arribada’
meaning ‘arrival’ in Spanish. The Gahirmatha beach in
Orissa is the world’s largest nesting ground of marine
turtles, with about two hundred thousand female ridleys
coming to nest.
The Olive Ridleys nest sporadically along the east
and west coasts of India while mass nesting was
observed only along the Orissa Coast. They are well
known for their synchronous nesting behaviour. The
females come to the shore crawling above the high water
mark mostly at night to dig a nest with their hind flippers.
After laying about 100 to 150 eggs they return to the sea
and the eggs hatch after 50 to 60 days. In India, in the
Orissa coast at Gahirmatha, Devi and Rushikulya the
female ridleys nest enmasse (Tripathy, 2002). The
marine turtles have stopped nesting at the Devi river
mouth now (Das, 2012). Gahirmatha has been recorded
as the world’s largest sea turtle rookery (Bustard, 1976).
It is located in the river mouth of Maipura between
Dhurma and Paradeep port (21° N - 87°E) (Tripathy,
2002). The mass nesting of Olive Ridleys in Gahirmatha
beach was first reported by Bustard (1976). The number
of turtles undergoing mass nesting ranged between 1,
00,000 and 8,00,000 (Pattanaik et al., 2001). Normally
the first arribada is followed by a second one of lower
intensity after about 45-60 days (Dash and Kar, 1990;
Panday et al., 1994). Olive Ridleys are vulnerable due to
predation of eggs, loss of nesting sites and capture of
nesting adults for their flesh, skin and oil. The increased
human intervention in the coast of Goa known as a
popular tourist destination has affected the nesting
activity of the Olive Ridleys over the years (Das, 2004). In
the past, these turtles nested on nearly all the beaches in
Goa. But due to tourism activities in many beaches like
Calangute and Colva, turtles find it difficult to nest (Goyal
and Pathak, 2003). In 2012, hundreds of hatchlings were
predated by hovering crows and kites in the Rushikulya
river mouth in spite of the efforts taken by locals and
tourists. Many hatchlings were found dead in the nearby
beaches having got entangled in rejected fishing nets
(Das, 2012).
There is also a controversy brewing off the Orissa
coast over oil exploration near the mass nesting sites of
the Olive Ridley turtles. It was planned to carry out
exploratory drilling near the Gahirmatha Sanctuary and
Rushikulya river mouth. Lovers of wildlife fear that the oil
exploration would cross the migratory path of the
endangered Olive Ridleys. They are apprehensive that
the leakage or blow outs from the drilling well may have
disastrous effect on the turtles.
During the past ten years, more than 100,000 Olive
Ridleys have been killed by illegal fishing along the coast
of Orissa which is one of the three mass nesting sites in
the world hosting as much as 50 percent of the world’s
population
(Das,
2004).
The
scientists
and
environmentalists must urge the Indian authorities to take
immediate steps to protect the mass nesting sites of the
Olive Ridleys along the Orissa coast. To save the
endangered sea turtles, action must be taken against
mechanized fishing along the Orissa coast.
Conservative measures
Conservation and development have to be
integrated to ensure a sustainable future. In addition to
the protection offered by the Wildlife Protection Act of
1972 for a number of turtle species, Orissa’s campaign
against poachers of Olive Ridleys, Tamil Nadu’s
extensive hatchery programme in the Bay of Bengal,
research and publications on turtle conservation by the
CMFRI (Central Marine Fisheries Research Institute)
and the appointment of a sea turtle specialist group by
the Department of Environment to advise the
Government of India helped India to achieve progress in
sea turtle conservation.
Large land areas acquired as community reserves
near the beaches can provide safe nesting areas.
Moreover interpretation centres have to be established to
provide details about the life cycle of the turtles to local
people. In these reserves, human/ animal movement
must be prohibited during the nesting season, OctoberMay as the turtles require total privacy during
reproduction (Sastry, 2004). Nesting is affected by rainfall
as the Ridleys prefer a warm climate to lay eggs.
Predators have to be prevented from disturbing the eggs,
hatchlings and adults on the nesting beach for achieving
conservation. During fishing, by catch reduction devices
like Turtle Excluder Devices have to be used.
Conservation of green turtle nesting sites can be initiated
in Gujarat, Laccadives and Andaman and Nicobar
islands. Awareness programmes can be organized on
turtle conservation to make people aware of this
endangered species(Kabi, 2009). Awareness about the
significance of marine resources especially turtles and
the consequences of their destruction have to be created
among the public and fishing community. Studies related
to the identification, lifecycle, behavior, distribution,
nesting, feeding and reproduction of turtles may pave
way to take effective conservative measures.
Acknowledgments
The author thanks the authorities of The American
College, Madurai for encouragement.
References
Bustard, H. R. 1976. World’s Largest Sea turtle Rookery? Tiger
paper, 3, 25.
Das, I. 1985. Indian Turtles A Field Guide. WWF-India, Eastern
Region, Calcutta, India, 119p.
Das,P. 2004. Oil exploration near Olive Ridley turtle nesting
sites causes concern, The Hindu, 20 March 2004, p.15.
Das, P. 2012. Thousands of olive ridleys born, but not all are
lucky in seaward march. The Hindu, 19 April 2012, p20.
Dash, M.C and C.S.Kar. 1990. In: The Turtle Paradise:
Gahirmatha. Interprint, New Delhi. 295p.
Goyal, M and N.Pathak. 2003. Who will save the turtles? The
Hindu, 1 November 2003.
161
Kabi, B.K. 2009. Sea turtle conservation and habitat protection
in the buffer zone of the Gahirmatha sea turtle rookery,
Kendrapara, Orissa. Indian Ocean turtle Newsletter, 10, 3435.
Panday, B., B.L.Choudhary and C.S.Kar. 1994. In: A Status
Survey of Olive Ridley Sea Turtle (Lepidochelys olivacea)
and their Nesting Beaches Along the Orissa Coast, India.
Wildlife Institute of India, Dehradun, pp 1-48.
Pattanaik, S.K., C.S.Kar and S.K.Kar. 2001. In: A Quarter
Century of Sea Turtle
Conservation in Orissa, Forest
Department, Govt. of Orissa Publications, Bhubaneswar,
2001, pp1-34.
Sastry, A. 2004. Community reserves to protect Olive Ridleys.
The Hindu 7 November 2004, p.11.
Tripathy, B. 2002. Is Gahirmatha the World’s largest sea turtle
rookery? Curr.Sci. 83, 1299.
Bio-Ethics and Sustainable
Development: The Need for
Proper Policy Making
- S. Panneerselvam, Ph.D.
Professor and Head of Department of Philosophy,
University of Madras, Chennai, India
In the twentieth century, the discipline of philosophy
has witnessed many philosophical turns. Some of them
are: the linguistic turn, hermeneutical turn, the ecological
turn, feministic turn and phenomenological turn.
Philosophers began to look at philosophical problems
from different perspective. Thus there is a paradigm shift
from “arm-chair philosophy” to social oriented
philosophy”. Especially the hermeneutical turn and the
ecological turn gave a new methodology of upstanding
human problems and both these turns are interrelated.
The ecological turn may be defined as follows: “The
ecological turn, is not a single or univocal issue; on the
contrary, it stretches all the way from issues of pollution
of our rivers to the question of the relationships of
humans, the world and God. Every discipline and every
ideology, every system of morality and every form of
religion has to rethink their fundamentals in the light of
the ecological question, on pain of otherwise turning
themselves into engines of oppression”. This definition
clearly shows that there is a need for protecting the
environment and man cannot have an isolated life. His
life is interrelated with the nature and other living beings.
Similarly the hermeneutical turn explains the need
for rethinking and reunderstanding the philosophical
concepts. If we extend this scope, one can understand
the need to revisit our way of approach towards nature
and other living beings. Two aspects of hermeneutics
are: (1) the interrelation between the whole and the parts
and (2) the interrelation of the past and the present with
that of the future. Our attitude towards nature should be
such that that we must develop a holistic perspective
wherein one cannot have a compartmentalized
understanding of life. This means that in order to
understand the totality of life, we must know the validity
and the significance of parts, which include, nature as
well as other living and non-living things on earth.
Similarly we are always shaped by the past. Our
162
traditional values and ethos play a significant role in
shaping the present; not only the present but also the
future. Thus we see the interrelation between the
ecological turn and the hermeneutical turn. If we use this
methodology, a new way of understanding the
sustainable development will emerge.
The “bio-philia” conception that there is an innate
emotional affiliation of human beings to other living
beings is important in this context. A respect for life is
emphasized by many contemporary thinkers. One good
example is Leopold (1948). He argues in favour of a land
ethic, which includes soils, waters, plants and animals or
collectively, the land. “A thing is right when it tends to
preserve the integrity, stability, and beauty of the biotic
community. It is wrong when it tends otherwise”. In
Leopold, we see a need for a shift from human to nature.
Thus, we see in the contemporary approach an extension
of environmental aesthetics to plants and animals and to
nature. The animal rights philosopher like Peter Singer
and the Deep ecologists like Arne Naess and Warwick
Fox are representatives of this.
Peter Singer (2003) asks the question, whether a
non-human animal is a person and answers positively.
He explains how animals are used in experiment for the
sake of man. He narrates one such experiment in the
U.S. Armed Forces Radiobiology Institute at Maryland.
Here the rhesus monkeys are trained to run inside large
wheel. If they slow down too much, the wheel also slows
down and as a result, the monkeys get electric shock.
Once they are trained in this for some time, they are
given lethal doses of radiation. Then while sick and
vomiting, they are forced to continue to run until they
drop. This is supposed to provide information on the
capacities of soldiers to continue to fight after a nuclear
attack. Such experiments take away the rights of
animals. This is due to the wrong assumption that both
plants and animals exist for the sake of man. This is
nothing but exploitation.
Hans Jonas (1984) says that this would result in the
dehumanization of man. He explains how the future of
man lies in the future of nature. Similarly, Deep
ecologists like Naess raise deep questions about one’s
assumptions regarding ecological relationship. Naess
gives seven principles, which must be taken seriously in
the context of environmental aesthetics. These principles
are: rejection of the man-in-the-environment image in
favour of the relational, total field image, biospherical
egalitarianism-in principle, principles of diversity an of
symbiosis, anti-class posture, fight against pollution and
resource depletion, complexity, not complication, and
local autonomy and decentralization. Naess’ deep
ecology, otherwise known as “Ecosophy T” is explained
as follows: “I call my philosophy ‘Ecosophy T’, using the
character T just to emphasize that other people in the
movement would, if motivate to formulate their world view
and general value priorities, arrive at different
ecosophies: Ecosophy ‘A’, ‘B’, …, ‘T’, …, ‘Z’. By an
‘ecosophy’ I here mean a philosophy inspired by the
deep ecological movement.” (Naess, 1985).
Philosophy teaches how to live with our environment
with peace and free from conflict. But sufficient care has
not been taken to understand the traditional methods of
preserving nature. This has led to innumerable
environmental problems. The degradation of the
environment is leading to vast areas of the world and as
a consequence of this, the world, which we live in, is
becoming more and more unsuitable for human
habitation. A clean and hygienic environment is a basic
necessity for healthy living. Industrialization, unplanned
development and mechanization have spoiled the
environment considerably. The solution to the problem is
possible only through global understanding. If
sustainable development is to succeed as a new way of
life, its moral content should be well justified. The need of
the society is to transform the behaviour of the societies
towards the biosphere. A new ethic of embracing plants
and animals is required so as to live in harmony with
nature. Eminent environmental thinkers like R.C. Clark,
R. Elliot and P. Singer have emphasized the need to
protect the living beings on earth. It is the duty of humans
to take care of non-human beings also and hence
humankind has more moral responsibilities towards
earth. In the contemporary period in the West, the two
great thinkers, namely, Heidegger and Habermas have
attempted for an ethics, through their principle of deep
ecology and Discourse ethics respectively.
We live in a civilization that is threatened by the
uncontrolled growth of technology, deriving from the
empirical sciences, which have nothing to say about
human values. Modern civilization is radically rotten, and
only a complete transformation in theory and practice
could cure it. The environmental crisis facing industrial
society is so grave that humankind has to do something
to save the human society, as well as nature and other
living beings. In the present society, there is a public
demand for particular ethics for single profession of
vocation, a demand that is as unwarranted as if one were
to demand specific civic rights and laws for different
groups, communities within the same political entity
called State. The different professions and communal
groups of people may have different mores, but there
should only be one underlying set of ethical maxims,
principles as obligatory for all human beings, irrespective
of race, religion, nationality or other secondary qualities.
Thus the contemporary Western thinkers have been
contemplating the concept of “global ethics”.
In our present scientific technological civilization,
there is a need for protecting humans as well as the
environment. Every individual and every creature has
intrinsic dignity and inalienable rights, and each one of
them has an inescapable responsibility for what he does.
The role of bio-ethics, bio-safety, the ethical implications
of genetic engineering are important in the contemporary
society. Theoretical discussion of these issues will not
solve the problem. The solution to the problem lies in
application of the theories that are formulated to the
issues and this is possible only through the help of
philosophers. It deals with problems connected with
humankind and nature.
In the context of contemporary society, we are
talking about "Universal ethics" or "Global ethics". By
these terms we mean that certain ethical concerns apply
globally, not just within the borders of one country or
even to on culture. There are certain issues, which are
discussed globally and they are not restricted to one
region alone. In 1993, the important Conference held in
Rio de Janeiro, otherwise known as the "Earth Summit"
in which most of the nations participated. The basic idea
behind this Conference is to protect the earth. It is
because the earth, which we live in, faces a common
crisis and it is in the interests of all, we must join together
in combating it. Universal ethics is the synthesis of
different traditions and aspects of biological, social and
spiritual heritage that we have.
How to make this ideal a realistic one? A new move
in the ethical philosophy has sprung up under the name
environmental ethics, or environmental philosophy which
will give us a lead. It is true that what we discuss under
this topic is not totally new. Our ancient thinkers
conceived this idea and have spoken elaborately on it.
But the issue is more significant in this millennium
because of the fact that the problem we face today is to
be tackled immediately if humanity is to survive in the
future. It is not only concerned about the living of human
beings. Human beings must protect the plant and animal
kingdom. They should not think that the nature exists for
his use alone. They have to take care of every aspect of
nature. The rights and wrongs of our treatment of animals
are discussed at length in ethics. The ethics of population
growth and the use of natural resources have an
important part to play in the discussion of social or
distributive justice between nations. Now philosophers
understand their responsibility to consider questions of
moral responsibility and political organization in a global
context. The sense of a need to think afresh about
questions of ethics in international relations gains
importance from the belief that ecology has altered our
understanding of life. This means till now we have been
talking about issues connected with national boundaries
like, self-determination of peoples, implications of war,
nuclear deterrence etc. But now, environmental disaster
is a common threat to the whole humanity and hence
must be tackled immediately for the future survival of
man. This explains that there is a demand for a radical
re-thinking of moral parameters.
The increasing awareness that Western culture may
be breaking down has made us to search for causes and
examine facets of modern society, which we have
hitherto ignored, neglected and overlooked. In
technology, there is a focal point, in which conceptual
and ideological paths meet. To understand these
converging paths is to understand the main
configurations of the network within which our civilization
operates. For example, notions like progress, nature,
invention, rationality, efficiency etc., have a link with
culture. To put in simple terms, the philosophy of culture
is the philosophy of society, a philosophy of humankind in
a civilization which has found itself at an impasse, which
is threatened by excessive specialization, fragmentation
and atomization and which is becoming aware that it has
chosen a mistaken idiom for its interaction with nature. All
these problems to some extent are due to our wrong
approach to science and technology.
In the contemporary period, the need for such ethics
has been felt very much. Albert Schweitzer defines ethics
as human’s unlimited responsibility towards every living
being. Philosophers like Immanual Kant, Max Weber,
Hans Jonas, Jugen Habermas, Richard Hare, John
Rawls, and others have stressed this. Kant developed
the moral philosophy or philosophy of practical reason
during 1785 and 1797 and published three important
books namely, Foundation of the Metaphysic of Morals,
Critique of Practical Reason and Metaphysics of Morals.
The philosophy of practical reason or ethics is concerned
with that only which ought to be done, i.e., what should
163
be enacted by man’s action grounded in a free will,
whereas the philosophy theoretical reason or nature is
concerned merely with everything that is. Max Weber’s
ethics is known as “responsibility ethics”. He was guided
in his historical-sociological research by an idea which
was decisive in his construction of concepts and his
formation of theories; the idea of the rationalization of all
social fields. Max Weber rejected the dogmatic
interpretation of history and society, whether idealistic or
materialistic and has pointed out that in every
investigation of historical and social events one must ask
a basic question namely, whether such an inquiry is
strictly, factual. His study on Protestant Ethics and the
Spirit of Capitalism is a typical example of his approach
to the socio-hisorical phenomena. Similarly, Hans Jonas’
The Imperative of Responsibility in Search of an Ethics
for the Technological Age is an investigation with a
reconsideration of the ethical key-concept freedom and
like Kant he takes man’s free will as the metaphysical
condition of morality. According to him, in so far as
technical science has extended man’s educative power
up to the point where it becomes sensitively dangerous to
world as such, it also extends man’s responsibility for
future life on earth. Thus human responsibility becomes
for the first time cosmic. It needed the obvious
endangering of the whole system, the factual beginnings
of its destruction, to make us discover or rediscover our
solidarity with the whole world. Habermas’ Discourse
ethics or theory of communication attempts to serve the
purpose of critically analyzing various possibilities of
morally responsible acting, thus aiming at guidelines for a
morality justifiable life in our technological world. The
main objective of his Discourse Ethics is to re-formulate
and re-assess Kant’s formalistic moral theory, in
particular the justification of ethical norms and principles
by employing the means of communication by saying that
moral questions can be by rational reflection and
discourse.
In Indian tradition importance is given to animals
and plants and it considered them as sentient beings,
and even inanimate phenomena of nature like mountains
and rivers, the sun and the moon--all endowed with life.
The Vedic deities are personification of natural
phenomena--the fire and the wind, the sun and the
moon, the river and mountains, the day and the night. It
is not a kind of poetic personification alone. The mystic
seers of the Vedic hymns could realize the divine
presence in every phenomena of nature and also
understand that it is the same reality that appeared in
different ways. This tendency is found even in later
classical Sanskrit literature. In the Kumarasambhava,
Kalidasa describes the Himalayas as Devatatma, the
heroine, Parvati is the daughter of Himavan. Ganga and
Sarasvati are rivers as well as deities.
In the context of contemporary problems of
environmental destruction and pollution, we have to look
all the harmony which existed between man and nature
in ancient India, especially in the hermitage of Kanva and
Marica in the Abhijnana Sakuntala and Vasistha in the
Raghuvamsa. This is in contrast to the Western concept
of dominance and exploitation and environmental
destruction. Even in classical Sanskrit literature we often
come across the contrast between the calm and serene
atmosphere of peace and harmony found in the
hermitages and the suffocating activities of the crowd in
164
the cities expressed by the young sage accompanying
Sakuntala to the court of Dusyanta.
The theory of Samsara emphasizing karma and
rebirth applied not only to human beings. The ten
incarnations of Visnu as fish, tortoise, boar etc. are well
known. The Ramayana refers to the story of Ahalya
being cursed to become a stone for long until Lord Rama
resurrected her by the touch of his foot. The Bhagavata
refers to Kubera's sons Nalakubara ad Manigriva being
cursed to lead the life of two trees, until Krishna rescued
them from the curse. The story of King Nrga who had to
suffer as chameleon till Krishna saved him is also known.
If cutting of trees and clearing part of a forest become
necessary as for the construction of a temple, the deities
or spirits presiding over the trees had to be requested
with elaborate mantras to move out without making
trouble, since a temple of God is to be constructed there.
The concept of Vanadevatas or deities presiding over the
forests is suggestive of the importance given to the
planets and trees. The unsophisticated village man and
women treated nature as part of their household. Sri
Aurobindo believed that evolution is not always
straightforward and that it often entailed involution also.
Human and semi divine beings born as animals after
death are quite frequent in our Puranas. The story of
Gajendramoksa and Jadabharata being born as a deer
exemplify this. The Hindu gods and goddesses were
closely associated with their favorite animals and plants
or trees. Thus Indian tradition always responded
sympathetically to nature with human behaviour.
Personification of insentient nature was often considered
as a defect in western literature and philosophical
methods, but Indian writers considered it as quite
appropriate.
There is an inseparable relation between eco
conservation and sustainable development. They are like
two sides of the same coin. The eco system is not a mere
collection of living and non-living things but an intricate
connection between these various elements. It is
because of this reason that the living things receive
energy and matter from the environment and convert
these into living matter. Sustainable development meets
the needs of the present without compromising the ability
of future generations to meet their own needs.
What is important at present is environmental
auditing. It is a mechanism for assessing the impact of an
existing industrial or commercial operations on the
environment. It needs collection, evaluation and
documentation of sufficient evidence to establish that the
operation is in accordance with the standards. The eco
system has its own limits to the amount of disturbance it
can sustain. The balanced equilibrium of the eco
conservation as a whole, works to the mutual benefit of
living and non-living things. Eco philosophy culminates in
transpersonal ethics, which transcends the individualistic
and egoistic aspects.
How far this is acceptable? How far this
transpersonal approach to ethics is acceptable in the
context of globalization? Environmental management
systems (EMS) are now growing in importance as a
voluntary body for corporation to institutionalize
environmental responsibility operations. Two main
initiatives for certifying EMS are: the Eco Management
and Audit Scheme (EMAS) and the International
Organization for Standardization (ISO). There is a
demand for getting ISO certificate, which shows the
environmental awareness among the people of India.
The need for re-thinking and re-ordering the
contextual relation between nature and history is studied
in the contemporary society. According to many, the
"ecological repentance" is needed to understand the real
relation between man and nature. Eco-humanism talks
about the uniqueness or special status of humans
precisely in their relationship to nature. Here one can
make a distinction between: (1) separative humanism
and (2) participatory humanism. The first one is
autocentric whereas the second is allocentric, which
allows openness. Marjorie Grene, for example talks
about participatory humanism to explain the need to
reinterpret the human in terms of nature. The
participatory humanism attempts to interpret the
attributes of human. The human is special not in
transcending nature, we may say but in being specially
related to it, not transcendence, but a special and unique
mode of participation is what characterizes the human.
Thus it can be argued that only an interpretational
understanding of the term “sustainable development” is
the need of the hour. We have to take care of everything,
i.e., both beings and non-being which alone will help us
to preserve the nature for the future generations.
References
Hans Jonas, The Imperative of Responsibility in Search of an Ethics for
the Technological Age, Chicago: The University of Chicago Press,
1984. p. 136.
Leopold, A. A Sand Country Almanac, and Sketches Here and There,
New York: Oxford University Press, 1968, (first published in 1949),
pp. 224-25.
Naess, A. "Identification as a Source of Deep Ecological Attitudes", in
M. Tobias (ed.), Deep Ecology, San Diego: Avant Books, 1985, p.
258.
Singer, P. Practical Ethics, Cambridge: Cambridge University Press,
Second Edition, 2003, p. 66.
Human cloning: Comments
on Iftime (2012)
- K. K. Verma, Ph.D.,
Retired Professor of Zoology, HIG 1/327, Housing Board
Colony, Borsi, DURG – 491001, INDIA
Iftime (2012), writing on human cloning, has pointed
out that there has been a lot of debate and discussion on
philosophy and theology of cloning, but to a much lesser
extent on its scientific and biological aspect. The
biological objections to human cloning definitely need
more attention. These objections have been discussed at
some length by Verma and Saxena (1999).
Iftime (loc. cit.) has correctly said that in cloning
gene function is affected. Verma and Saxena (loc. cit.)
have drawn attention to the fact that the following two
steps of normal sexual reproduction are missing in
cloning, and that this in main is responsible for
malfunctioning of genes.
Parental imprinting
In sexual reproduction a haploid set of maternal
chromosomes and a similar set of paternal chromosomes
165
come to lie together in the fertilized egg. In the resulting
diploid set the genes in
the corresponding or
homologous chromosomes behave differently due to
parental imprinting. In cloning, however all the
chromosomes
are
either
maternally
imprinted
(gynogenote) or paternally imprinted (androgenote),
depending upon of which sex the nucleus donor is. In
either case the resulting embryo has been observed to
show various developmental anomalies.
References
Nucleocytoplasmic interaction
This interaction also affects gene function. It has
been experimentally shown that, if the
egg and the
sperm nucleus, coming together in fertilization are from
different strains of mice, the following development is
abnormal. It may be recalled that during fertilization the
sperm transfers to the egg only its nucleus, and almost
no cytoplasm.
Due to such anomalies in gene function the resulting
clone is with abnormalities. Researchers in USA
attempted cloning of Indian bison, but the resulting clone
(named as Noah) died just 48 hours after its birth (Meek,
2001). If I remember correctly, the first cloned sheep,
Dolly, cloned in 1993, suffered from severe premature
arthritis. Certainly we would not like to add to our
population cloned individuals, suffering from various
abnormalities.
Human cloning, also due to following social reasons,
is undesirable:
(a) This will disturb the family structure.
(b) A human clone is likely to suffer from being singled
out, and may even face social hostility.
If and when we plan to produce a human clone, it
may not be just producing a clone; we may be tempted to
produce a clone of an individual, who has made a
landmark contribution in a certain area of human activity,
say a clone of Einstein. But we have to remember that, in
shaping the personality and aptitude of a human
individual, his/her cultural inheritance is almost as
important as his/her genetic inheritance. The cultural
effects on a growing human becomes very significant
because of an extra long period of psychological
immaturity, a long post-natal association with parents and
other elders in the society, and institutional learning. In
order to get another Einstein through cloning we have
recreate for the clone the cultural environs, in which the
original Einstein grew up, and that would be extremely
difficult, if not impossible.
In view of the biological and sociological objections
to human cloning, outlined above, it is very appropriate
that UNESCO in their “Report of IBC on human cloning
th
and international governance”, published on 9 June
2009, have described human cloning as “contrary to
human dignity”.
Conferences
For a list of some ethics meetings in Asia and Pacific:
http://eubios.info/conferences
Iftime, O., 2012. Will humans never be cloned because of God,
biology or language? EJAIB, 22(3) (May 2012): 128 – 130.
Meek, J., 2001. Cloned Indian bison dies. Hindustan Times,
New Delhi, January 15, 2001.
UNESCO, 2009. Report of IBC on human cloning and
th
international governance. 9 June 2009.
Verma, K. K., and Saxena, R., 1999. Human cloning: A
biological objection to it. Resonance, 4(9): 38 – 43.
Sixth UNU-University of Kumamoto Bioethics
Roundtable: Bioethics from Theory to Practice, 8-10
December 2012, Kumamoto, Japan. Email: Kimiko
Tashima <[email protected]>
EJAIB Editor: Darryl Macer
Associate Editors
Jayapaul Azariah (All India Bioethics Association, India),
Masahiro Morioka (Osaka Prefectural University, Japan).
Editorial Board: Akira Akabayashi (Japan), Sahin Aksoy
(Turkey), Angeles Tan Alora (Philippines), Atsushi Asai
(Japan), Alireza Bagheri (Iran), Gerhold Becker
(Germany), Napat Chaipraditkul (Thailand), Shamima
Lasker (Bangladesh), Minakshi Bhardwaj (UK), Christian
Byk (IALES; France), Ken Daniels (New Zealand),
Leonardo de Castro (The Philippines), Ole Doering
(Germany), Amarbayasgalan Dorjderem (Mongolia),
Thomas Gionis (USA), Dena Hsin (Taiwan), Sawa Kato
(Japan), Rihito Kimura (Japan), Abby Lippman (Canada),
Margaret Lock (Canada), Umar Jenie (Indonesia),
Nobuko Yasuhara Macer (Japan), Anwar Nasim
(Pakistan), Jing-Bao Nie (China, New Zealand), Pinit
Ratanakul (Thailand), Qiu Ren Zong (China), Hyakudai
Sakamoto (Japan), Sang-yong Song (Republic of Korea);
Noritoshi Tanida (Japan), Ananya Tritipthumrongchok
(Thailand), Yanguang Wang (China), Daniel Wikler
(USA), Jeong Ro Yoon (Republic of Korea).
Editorial address:
Prof. Darryl Macer, Director, Eubios Ethics Institute,
c/o Center for Ethics of Science and Technology,
Chulalongkorn University, Faculty of Arts, Chulalongkorn
University, Bangkok 10330, Thailand
How to order books or journal or the CD!
Cheques in local currency are accepted from accounts with major banks in Australia, Canada, New Zealand, USA,
U.K. (The currency has to be the same as the address of the bank, and the cheque made out to "Eubios Ethics
Institute").
Please use the renewal form enclosed and prices are below: Other currencies (use a bank or post draft) and
credit cards use NZ$ for the Overseas price.
In Japan use postal transfer to the "Eubios Ethics Institute" account 00340-9-32465.
Eubios Ethics Institute Publications (Books sent by SAL post, Journal by Airmail - Price included)
Eubios Journal of Asian and International Bioethics
Other countries/credit card
Price:
US$60 Euro 40 NZ$70 ¥4000
(Credit card price NZ$90)
Shaping Genes: Ethics, Law and Science of Using Genetic Technology in Medicine and Agriculture
by Darryl Macer, Oct. 1990, 421pp.
Cost: US$20 UK£10 NZ$30 A$25 C$22 ¥2500 Others or credit card NZ$30
Equitable Patent Protection in the Developing World
by William Lesser, May 1991, 150pp.
Cost: US$15 UK£8 NZ$20 A$20 C$17 ¥1500
NZ$25
Attitudes to Genetic Engineering: Japanese and International Comparisons (Bilingual)
by Darryl Macer, May 1992 330pp.
Cost: US$30 UK£15 NZ$35 A$30 C$30 ¥3000
NZ$40
Human Genome Research & Society
Eds: Norio Fujiki & Darryl R.J. Macer July 1992 ISBN 0-908897-03-0
(English), 230pp. ISBN 0-908897-04-9 (Japanese), 240pp. Cost: US$20 UK£10 NZ$30 A$25 C$22 ¥2000
NZ$30
Intractable Neurological Disorders, Human Genome Research and Society Eds: N. Fujiki & D. Macer
Feb. 1994 ISBN 0-908897-06-5 (English), 320pp. ISBN 0-908897-07-3 (Japanese), 340pp.
Cost: US$25 UK£12 NZ$30 A$30 C$27 ¥3000
NZ$40
Bioethics for the People by the People
by Darryl Macer,... May 1994 ISBN 0-908897-05-7, 460pp. Cost: US$30 UK£15 NZ$35 A$35 C$32 ¥3000
NZ$50
Bioethics in High Schools in Australia, Japan and New Zealand,
by D. Macer, Y. Asada, M. Tsuzuki, S. Akiyama, & N.Y. Macer March 1996, ISBN 0-908897-08-1, 200pp.(A4)
Cost: US$25 UK£15 NZ$30 A$30 C$30 ¥2000
NZ$40
Protection of the Human Genome and Scientific Responsibility (Bilingual)
Editors: Michio Okamoto, Norio Fujiki & D.R.J. Macer,
April 1996, ISBN 0-908897-09-X, 210pp.
Cost: US$25 UK£15 NZ$30 A$30 C$30 ¥2500
NZ$35
Bioethics in India (includes 115 papers from Jan.1997 conference)
Eds: Jayapaul Azariah, Hilda Azariah & Darryl R.J. Macer
June 1998 ISBN 0-908897-10-3, 403 pp.
Printed in India)
Cost: US$30 UK£18 NZ$34 A$36 C$36 ¥3000
NZ$45
Bioethics is Love of Life: An alternative textbook
by Darryl Macer, July 1998 ISBN 0-908897-13-8, 152pp. Cost: US$26 UK£14 NZ$34 A$34 C$32 ¥3000
NZ$40
Bioethics in Asia (includes 118 papers from Nov.1997 conferences, ABC’97 Kobe and Fukui Satellite)
Eds: Norio Fujiki & Darryl R.J. Macer
Cost: US$36 UK£20 NZ$40 A$38 C$40 ¥3000
NZ$50
June 1998 ISBN 0-908897-12-X, 478 pp. October 1999 ISBN 0-908897-14-6 (Japanese), 320pp.
Ethical Challenges as we approach the end of the Human Genome Project
Editor: Darryl Macer, April 2000 ISBN 0-908897-15-4, 124pp. Cost: US$20 UK£12 NZ$30 A$30 C$30 ¥2500 NZ$35
Bioethics Education in Japanese High Schools (in Japanese only)
Editor: Darryl MacerApril 2000 ISBN 0-908897-16-2, 112pp. Cost: US$20 UK£12 NZ$30 A$30 C$30 ¥1000
NZ$35
st
Bioethics and the Impact of Human Genome Research in the 21 Century
Eds: Norio Fujiki, Masakatsu Sudo, & Darryl R.J. Macer March 2001 (English and Japanese bilingual, 350pp).
Cost: US$30 UK£20 NZ$40 A$38 C$40 ¥3000
NZ$50
st
Bioethics in Asia in the 21 Century
Eds: Song Sang-yong, Koo Young-Mo & Darryl R.J. Macer
August 2003 ISBN 0-908897-19-7, 450pp. Cost: US$35 Euro35 UK£20 NZ$40 A$38 C$40 ¥3000
NZ$50
Challenges for Bioethics from Asia
Ed: Darryl R.J. Macer
November 2004 ISBN 0-908897-22-7 656 pp. Cost: US$35 Euro35 UK£20 NZ$40 A$38 C$40 ¥3000
NZ$50
A Cross Cultural Introduction to Bioethics
2006, 300pp. (A4)
Editor: Darryl Macer
Cost: US$35 Euro35 UK£20 NZ$40 A$38 C$40 ¥3000
NZ$50
The Eubios CD-ROM
all journals + all books ++ (English version) US$190
NZ$400
Please send a copy of the whole page.
Please find my cheque for:
I wish to receive a free copy (only for developing countries)
Please charge my VISA / MASTERCARD card for NZ$
Account #
Expiry Date
Signature
Want to join the IAB Bioethics and
Date (D/M/Y)
Genetics Network(Yes/No)
Mailing address:
Email:
Fax:
Research Interests (for Network)
You can Email this order page to: [email protected])
Eubios Journal of Asian and International Bioethics 21 (May 2011)
167
ASIAN BIOETHICS ASSOCIATION
MEMBERSHIP 2012
and 2012 subscription to Eubios Journal of
Asian and International Bioethics (EJAIB)
____ I wish to pay my annual membership fees of Asian Bioethics Association (ABA), and receive the 2012
issues of Eubios Journal of Asian and International Bioethics (EJAIB) (The Official Journal).
____ Regular Price:
US$60 Euro 40 NZ$70 ¥4000 (=Credit card price NZ$90)
____ I wish to make a reduced contribution of
____ I wish to register as a member of Asian Bioethics Association, but am not in the position to pay a fee. I
understand that I should be satisfied with Internet access to Eubios Journal of Asian and International
Bioethics (EJAIB) <http://eubios.info/EJAIB.htm>.
____ I wish to make a donation to Eubios Ethics Institute of ____
____ I wish to receive the 2012 issues of EJAIB but not ABA membership, the price is:
____ Regular Price:
US$50 Euro 40 NZ$70 ¥4000 (Credit card price NZ$70)
____ Exchange subscription with journal, newsletter, etc. (Name____________________ )
____ I agree / ____ do not agree to my name being listed on the ABA www site
List Research Interests to be included:
I order the following Eubios Ethics Institute books:
Post or send an E-mail with your address* (or include current address label)
To: Prof. Darryl Macer,
E-mail: [email protected]
Please find my cheque for:
Note: Cheques in local currency are accepted from accounts with major banks in EU, New Zealand and USA. For
cheques please add US$20 or NZ$20 processing fee if not in NZ dollars. Please find my cheque for:
(The currency has to be the same as the address of the bank, and the cheque made out to "Eubios Ethics Institute").
Other currencies use a bank or post draft in NZ$ for the Overseas price. In Japan use postal transfer to the "Eubios
Ethics Institute" account nr: 00340-9-32465. Or authorize a one time credit card payment as below:
Please charge my VISA / MASTERCARD card (circle) for NZ$
Account #
Signature
**
Expiry Date
Name:
*Mailing address:
E-mail:
Fax:
** Other Eubios books / CD may be ordered with 25% discount at the time of renewing the subscription.
E-mail to: [email protected]
Web site: <http://eubios.info/ABA.htm>

Eubios Journal of Asian and International Bioethics

Transcription

Similar documents

orl/ii*ot

Republic of Kazakhstan: Te current situation on abortion

Women on Waves abortion sends drone to Poland

11 Ch 11 Children and Choice

iPPlus Sales Sheet - IP Plus Consulting, Inc.

Judge denies Bevin`s request to close Lexington

No Exceptions

New Fuel Standards: Clean and Green

Medicinsk abort gravv 9-13

Winter 2015 - Assist Pregnancy Center